ALZHEIMER Dra Maria Caecilia NS,M.Sc,Apt

Demensia adalah penurunan kemampuan mental yang biasanya berkembang secara perlahan, dimana terjadi gangguan ingatan, fikiran, penilaian dan kemampuan untuk memusatkan perhatian, dan bisa terjadi kemunduran kepribadian., timbul perlahan, menyerang usia > 60 tahun Alzheimer merupakan sejenis penyakit penurunan fungsi saraf otak yang kompleks dan progresif yang di sebabkan karena berkurangnya gizi di otak. Penyakit Alzheimer bukannya sejenis penyakit menular. Penyakit Alzheimer adalah keadaan di mana daya ingatan seseorang merosot dengan parahnya sehingga pengidapnya tidak mampu mengurus diri sendiri.

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Definisi Penyakit alzheimer sindrom demensia yang ditandai dgn penurunan ingatan dan kemampuan kognitif pasien secara progresif

In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary tangles). Plaques and tangles in the brain are two of the main features of AD. The third is the loss of connections between nerve cells (neurons) in the brain www.alz.org

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Patogenesis Pasien mengalami atrofi kortikal dan berkurangnya neuron secara signifikan, terutama saraf kolinergik (limbik otak dan korteks) Terjadi penurunan jumlah enzim kolin asetiltransferase di korteks serebral dan hippocampus Di otak, dijumpai amyloid plaques dan neurofibrillary yg terpusat pd daerah yg sama

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Difficulty performing familiar tasks Problems with language Gejala dan Tanda Memory loss Difficulty performing familiar tasks Problems with language Disorientation to time and place Poor or decreased judgment Problems with abstract thinking Misplacing things Changes in mood or behavior Changes in personality Loss of initiative www.alz.org

Penyebab dan Faktor Resiko Age Family history Genetics (heredity) Penyebab dan Faktor Resiko Lain yg Mungkin mempengaruhi Head injury General healthy aging www.alz.org

Diagnosis ask questions about the person’s overall health, past medical problems, ability to carry out daily activities, and changes in behavior and personality conduct tests of memory, problem solving, attention, counting, and language carry out medical tests, such as tests of blood, urine, or spinal fluid perform brain scans, such as a computerized tomography (CT) scan or a magnetic resonance imaging (MRI) test www.nia.niv.gov

Stage Of Alzheimer Stage 1:No impairment (normal function) Stage 2:Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer's disease) Stage 3:Mild cognitive decline Stage 4:Moderate cognitive decline (Mild or early-stage Alzheimer's disease) Stage 5:Moderately severe cognitive decline (Moderate or mid-stage Alzheimer's disease) Stage 6:Severe cognitive decline (Moderately severe or mid-stage Alzheimer's disease) Stage 7:Very severe cognitive decline (Severe or late-stage Alzheimer's disease) www.alz.org

Terapi Non farmakologi Melibatkan pasien, keluarga, atau pengasuh khusus untuk mensupport, menghadapi, dan memahami kondisi pasien. Farmakologi Terapi untuk mengatasi gejala penurunan kognisi atau menunda progresivitas penyakit Terapi simptomatik

Terapi Menunda Progresivitas Penyakit Inhibitor kolinesterase ↑↑ Asetilkolin contoh : takrin, donepezil, rivastigmin, galantamin. Antagonis reseptor NMDA : memantine Antioksidan, contoh : vitamin E, selegilin

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Terapi simptomatik Pasien yg disertai depresi : antidepresan (SSRI, TCA) Insomnia hipnotik atau antidepresan yg bersifat sedatif Delusion antipsikotik (klozapin, quetiapin, risperidon)

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