fk-usu fungsi luhur 2013.ppt
TRANSCRIPT
GANGGUAN FUNGSI LUHUR(NEUROBEHAVIOR)
Aldy S. Rambe
Departemen Neurologi FK-USU/
RSUP H. Adam Malik Medan
Pendahuluan
Selain berhubungan dengan gerakan, sensasi
dan organ sensorik spesifik, korteks
merupakan substrat untuk fungsi komprehensi,
kognisi dan komunikasi
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Stimulus Integrasi Respon
Integrasi semua impulsafferen pada korteks serebri
Bila terjadi ggn integrasi ,terjadi :Gangguan fungsi luhur(Gangguan fungsi kortikal)(Gangguan kualitas kesadaran)
Gangguan berupa:1. Ggn orientasi2. Ggn ingatan3. Ggn intelegensia4. Ggn kendali diri5. Ggn pertimbangan
BERBAHASA DAN BICARA
Fasikulus arcuata jaras asosiasi dalam white matter hubungkan area Wernicke dan Broca
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AFASIA Gangguan berbahasa akibat kerusakan otak
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Afasia tanpa gangguan pengulangan
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Aleksia Ketidakmampuan untuk membaca sbg bgn sindroma afasia atau sebagai abnormalitas
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AgnosiaKesulitan dalam pengenalan
dan identifikasi objekBiasanya disebabkan
gangguan pada fungsi asosiasi korteks serebri
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ApraksiaKetidakmampuan melakukan aktivitas motorik secara benar, meskipun jaras motorik dan sensorik utuh, dan pemahaman baik
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DEMENSIADEMENSIA
Dementia is an acquired loss of cognitive function due to an abnormal brain condition.
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DEMENSIADEMENSIA
Minimal melibatkan gangguan2 fs berikut :MEMORI + bahasa
fs visuospasialkalkulasijudgementberpikir abstrakproblem solving skills
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WHAT ARE THE CAUSES ??WHAT ARE THE CAUSES ??
• COMMON CAUSES :Alzheimer’s disease, multi infarct or vascular dementia , Lewy body dementia, pseudodementia.
• UNCOMMON CAUSES :toxins, vitamin deficiencies, endocrine disturbances, chronic metabolic conditions, vasculopathies of the brain, structural abnormalities, CNS infections
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Alzheimer’s Disease
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DEMENSIA ALZHEIMER
• Dulu : Dx berdasarkan otopsi
• Sekarang : klinis + pemeriksaan penunjangakurasi 85 - 95%
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AP=amyloid plaquesNFT=neurofibrillary tangles Courtesy of Grossberg G, St. Louis University
AD
NFTAP
Normal
Neuropathologic changesNeuropathologic changescharacteristic of Alzheimer’s disease (AD)characteristic of Alzheimer’s disease (AD)
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PROSEDUR DIAGNOSTIK
SKRINING :• Anamnesa riwayat perjalanan penyakit• Test psikometrik/neuropsikologisDIAGNOSTIK :• Konfirmasi (neurolog, psikiater, geriatrist)• Pemeriksaan penunjang (lab, radiologi, dll)• Rencana penatalakasanaan
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Who is going to be screened ??
““Screening for cognitive Screening for cognitive impairment among impairment among
asymptomatic persons is asymptomatic persons is not recommended “not recommended “
(WHO Technical Report Series(WHO Technical Report Series 730) 730)
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SCREENING INSTRUMENTSSCREENING INSTRUMENTS
• Mini Mental State Examination (MMSE)• Clock Drawing Test• Functional Activities Questionnaires (FAQ)• Geriatric Depression Scale• Ischemic Hachinski Score
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CLOCK DRAWING TEST
• To assess : Executive functions(frontal lobe) Visuospatial (parietal lobe)
• Method : Ask the patient to draw a clock Place the numbers in correct place Ask the patients to draw clock hands that shows ten minutes pass eleven
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Lingkaran tertutupLingkaran tertutup Skor Skor 11
Meletakkan angka Meletakkan angka pada posisi yang pada posisi yang benarbenar
Skor Skor 11
Memasukkan semua Memasukkan semua angka 12angka 12
Skor Skor 11
Meletakkan jarum Meletakkan jarum pada posisi yang pada posisi yang benarbenar
Skor Skor 11
CLOCK DRAWING TEST (cont.d)
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Examples of Clock DrawingExamples of Clock Drawing
Adequate clock Reversed numerals & incorrect hand placement.
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Diagnosing AD
There is currently no single test that accurately diagnoses Alzheimer's disease, so doctors use a variety of assessments and laboratory measurements to make a diagnosis
Medical history
Physical examinationStandard laboratory tests
Neuropsychological testingBrain-imaging scan
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NINCDS-ADRDA Alzheimer's Criteria
Definite Alzheimer's disease: probable Alzheimer's disease + histopathologic evidence of AD via
autopsy or biopsy.
Probable Alzheimer's disease: established by clinical and neuropsychological examination. Cognitive impairments also have to be progressive and be present in two or more areas of cognition.
Possible Alzheimer's disease: dementia syndrome with an atypical onset, presentation or progression; and without a known etiology; but no co-morbid diseases capable of producing dementia are believed to be in the origin of it.
Unlikely Alzheimer's disease: dementia syndrome with a sudden onset, focal neurologic signs, or seizures or gait disturbance early in the course of the illness.
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MANAGEMENT OF AD
• Managing the family• Managing the
environment• Managing the patient
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NON PHARMACOLOGICAL TREATMENT
• Train and support the family or caregiver• Environment intervention : physical, temporal,
sleep hygiene, deficits controlling, balance and healthy diet
• Behavior management : specific adaptation and modification for every single case.
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PHARMACOLOGICAL TREATMENT OF AD
DRUGS MECHANISM OF ACTIONcholine, lecithine precursor loadingbesipirdine, linopirdine neurotransmitter release
tacrine, donepezil AchE transferase inhibitor
rivastigmine, galanthamine
milameline, talsaclidine muscarinic agonistsXanomeline
Memantine NMDA receptor antagonist
TERIMAKASIH
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