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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