18-QUALITY OF LIFE AND ALZHEIMER: A SYSTEMATIC REVIEW FROM 2016 TO 2018

A systematic review was developed using the Methodi Ordinatio methodology proposed by Pagani, Resende and Kovaleski, (2015). This methodology consists of eight steps, described below: According to the Alzheimer's Association (2016), due to the progress of medicine, social conditions and environmental conditions, the number of Americans between 80 and 90 years tends to grow rapidly which consequently will increase the number of Alzheimer's Disease (AD) cases. By 2050, a new case of AD is expected for every 33 seconds, resulting in almost 1 million new cases per year. By 2025, the number of people aged 65 years or older with Alzheimer's disease is estimated to reach 7.1 million, an increase of almost 40%, compared to 5.2 million people aged 65 and over, 2016. By 2050, the number of people aged 65 years or older with Alzheimer's disease may almost triple from 5.2 million to 13.8 million.


INTRODUCTION
Alzheimer's is a brain degenerative disease and the most common cause of dementia.Dementia is characterized by the decline (resulting from loss of neurons) in memory, language, problem solving, and other cognitive abilities that affect one's ability to perform everyday activities.The damage and destruction of neurons eventually affect other parts of the brain, including basic bodily functions, like walking and swallowing.(ALZHEIMER'S ASSOCIATION, 2016) According to Pedroso et al. (2014), there is a growing concern with Quality of Life (QOL) in the last decades.QoL does not present a single concept, but presents three fundamental aspects: subjectivity, multidimensionality and the presence of positive and negative dimensions.Multidimensionality is divided into domains: physical domain, psychological domain, level of independence, social relations, environment and spirituality / religion / personal beliefs.(FLECK et al.1999).
The concept of QOL is complex, subjective and difficult to conceptualize (Farquhar, 1995).According to Rocha and Felli (2004), quality of life depends on intrinsic factors, that is, physiological changes, extrinsic factors such as social aspects and still a different view of quality of life for each individual as a result of their insertion in society.The WHOQOL Group (1998, p. 552) brings the concept of QOL as the "individual's perception of their life expectancies, goals and concerns".
Regarding the number of publications in the field of QOL and Alzheimer's, a total of 638 articles were identified in the period from 2016 to 2018, which approached the issue directly or indirectly.
In the treatment for Alzheimer's disease there is pharmacological treatment and non-pharmacological therapy, aiming to maintain or improve cognitive function, ability to perform daily activities and increase QoL, using, for example, art therapy, and cognitive activities such as gardening, cooking and games (Alzheimer's Association, 2016).
From this brief context, the present study aims to identify factors that interfere in the quality of life of people with Alzheimer's disease in the period 2016-2018.

METHODOLOGY
According to the research classifications proposed by Gil (2008), this research is bibliographical from the point of view of the object, basic from the point of view of its nature, with a qualitative approach from the point of view of the problem, exploratory about the objectives and finally, a research of the technical procedures.
Step 2 -Preliminary exploratory research with keywords in databases; Step 3 -Definition and combinations of keywords and databases; Step 4 -Definitive research in databases; Step 5 -Filtering Procedures; Step 6 -Identification of impact factor, year and number of citations; Step 8 -Location of articles in full format; Step 7 -Ordering of articles through InOrdinatio; Steps 1, 2, 3, 4 and 5 were performed as shown in Figure 1: The next step regarding step 7 of Methodi Ordinatio, the articles were ordered based on the InOrdinatio equation, following the formula 1: After applying this equation, we selected the 20 articles (17% of the total) that were most relevant to the full readings.
For the application of the method, Mendeley®, Jabref® and Excel® softwares were used to select articles by title, in order to bibliometric analysis through the insertion of JCR data and citations, as described in step 6.Of the 20 articles selected for the analysis of the research, ten articles were published in 2018, one was published in 2017 and nine were published in 2016.The countries where the studies were developed are identified in Figure 2:

RESULTS AND DISCUSSIONS
Quadro 1 -Resultado Final da Revisão sistemática After the application of Methodi Ordinatio and the elimination of articles after reading the titles and abstracts, the first 20 articles (17% of the total) were selected and placed in decreasing order by InOrdinatio, as presented in Table 1.
It is verified that the largest number of articles, are concentrated in Europe with 65% of the total of 20 articles.The Table 2 presents the main findings in the articles selected through Methodi Ordinatio, which relate the themes of Quality of Life and Alzheimer's.
Eight of the twenty studies analyzed deal with the question of social interaction as a factor that directly interferes with the QoL of people with Alzheimer's disease (HOFFMANN et al., 2016;OSMAN et al., 2016;SMIT et al., 2016;GIEBEL, CHALLIS e MONTALDI, 2016;KENIGSBERG et al., 2016;ADAM, RAMLI, SHAHAR, 2016;BELFORT et al., 2018;BALLARD et al., 2017).Four studies point out that physical activities positively influence QoL (HOFFMANN et al., 2016;ADAM, RAMLI e SHAHAR, 2016;GUEST et al., 2018;ARRIETA et al., 2018).The study of Lamb et al. (2016), found that physical training improved physical fitness, but did not bring improvements in daily activities, behavioral results or QoL.
It is possible to affirm that there is a relation between Quality of Life and Alzheimer's and to identify the main factors that interfere in the QoL of people with AD. (SMIT et al., 2016;SUN et al., 2018, GIEBEL, CHALLIS e MONTALDI, 2018;HONGISTO et al., 2018).Another factor present in three of the studies analyzed is related to the environment.For Kenigsberg et al. (2016) to develop a logical approach to a dementia care environment through organizational, architectural, and psychosocial interventions, help reduce symptoms in people with dementia and improve QoL.Such interventions can make friendly environments for dementia, culture and domesticity.In this context, Van Gennip et al. ( 2016), points out that living at home most of the time, when possible, tends to improve the QoL of individuals with AD.Rapp et al. (2018), compares the permanent (nursing home) and temporary stays, both are associated with a decrease in the burden of informal caregivers, but only permanent stays lead to an improvement in the patients' QoL because they reduce the risk of agitation and irritability.BALLARD, C. et al.Impact of antipsychotic review and non-pharmacological intervention on health-related quality of life in people with dementia living in care homes: WHELDa factorial cluster randomised controlled trial, Int.J. Geriatr.Psychiatry, v. 32, n. 10, p. 1094Psychiatry, v. 32, n. 10, p. -1103Psychiatry, v. 32, n. 10, p. , 2017.ADAM, D.; RAMLI, A.; SHAHAR, S. Effectiveness of a combined dance and relaxation intervention on reducing anxiety and depression and improving quality of life among the cognitively impaired elderly, Sultan Qaboos Univ.Med. J., v. 16, n. 1, p. e47-e53, 2016.Psychiatry Neurol., v. 31, n. 1, p. 27-33, 2018.

CONCLUSION ACKNOWLEDGEMENT
In only one study, but not less important, it is pointed out that music activity offers multiple health and wellness benefits to people with dementia and their caregivers.Group music activity facilitates a sense of belonging and promotes improvements in mood.The activity facilitated acceptance of the diagnosis of dementia, which may help promote long-term well-being (OSMAN et al., 2016).The AD patients are more accurate to remember sung lyrics, while healthy adults did not present significant difference.By observing these differences, it was suggested that brain processing areas of brain can be spared in AD and also that music increases excitement and therefore, better attention and better memory.(SIMMONS-STERN, BUDSON, ALLY, 2010) Cognitive therapy was pointed out in two studies as a positive factor in QOL.(LAVER et al., 2016;LIN et al., 2018).Kallio et al. (2018), did not identify a significant influence of cognitive therapy on QOL in his studies.
Another factor related to QoL present in two articles analyzed is depression, characterized as a neuropsychiatric symptom.Conde-Sala et al. (2016) cites depression, apathy and agitation as negative factors to QoL.Barbe et al., (2018), points out that depression strongly influences QoL, however, depression may be difficult to identify, since certain depressive symptoms may be confused with symptoms of dementia, such as apathy or decreased energy.The same study identified in a lower score, that polypharmacy (intake of three or more medications per day), is linked to a lower QoL.
This study aimed to identify factors that interfere in the QoL of people with AD.The study was carried out through a systematic review in the period of 2016 to 2018, in which it was possible to confirm the relation between QoL and AD in 20 articles mapped and analyzed.The results point out that the main factors that interfere positively, which tend to improve QoL measures: social interaction, daily activities, physical activities, a friendly and permanent environment, musical activities and therapy cognitive.The identified factors that negatively influence QoL are: depression, apathy, agitation, polypharmacy and increased cognitive impairment of the individual.It is important to emphasize that factors influencing QoL may present different results depending on the stages of AD cognitive impairment.According to Hongisto et al., (2018), when neuropsychiatric symptoms increase with the progression of AD, QoL decreases.Deficits in consciousness can interfere in the relationships and social interaction of individuals or interfere with daily activities.
It is worth mentioning that it is not possible to affirm that the factors identified in this study could reduce the progression of AD, such factors were analyzed in 20 studies related to their influence on the QoL of patients with AD only.According to Hongisto et al., (2018), it is not recommended that the use of QoL as a measure of success for the treatment of neuropsychiatric symptoms, since clinical treatment is indispensable.As a future study, it is proposed to perform systematic analyzes of each factor mentioned in this study, in order to obtain the deepening of the research.