alzheimer disease ????
DESCRIPTION
ALZHEIMER DISEASE ????. Alzheimer Disease. Suatu gangguan psikiatri yang merupakan bentuk progresifitas dari dementia , yang berefek pada gangguan kognitif, behavior, dan fungsional - PowerPoint PPT PresentationTRANSCRIPT
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ALZHEIMERDISEASE
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Alzheimer Disease
• Suatu gangguan psikiatri yang merupakan bentuk progresifitas dari dementia, yang berefek pada gangguan kognitif, behavior, dan fungsional
• penyakit penurunan fungsi otak yang kompleks dan progresif sehingga daya ingat seseorang merosot tajam dan tidak dapat disembuhkan.
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Etiologi– Belum diketahui secara pasti– Kemungkinan faktor genetik dan lingkungan
sedang diteliti (gen ApoE atau β-secretase)
Faktor Resiko– Usia– Riwayat keluarga– Hipertensi– Peningkatan LDL– Penurunan HDL– Diabetes
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Patogenesis
1. Atrofi kortikal
2. Neurofibrillary Tangles (NFTs)
3. Plaque Amyloid
4. Kerusakan saraf kolinergik
5. Penurunan sintesis asetilkolin
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1. Atrophy
3. Neurofibrillary tangles
2. Amyloid Plaques
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Beta-amyloid Plaques• dense deposits of βprotein and cellular material that accumulate outside and around nerve cells
Amyloid precursor protein (APP) is the precursor to amyloid plaque.
1. APP sticks through the neuron membrane.
2. Enzymes cut the APP into fragments of protein, including beta-amyloid.
3. Beta-amyloid fragments come together in clumps to form plaques.
Beta-amyloid juga dijumpai pada geriatri normal, tetapi tidak terkonsentrasi pada korteks/limbik
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Neurofibrillary tangles (NFTs)Terjadi karena adanya hiperfosforilasi dari protein tau,
sehingga menyebabkan mikrotubul kolaps
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4. Terjadinya penurunan aktifitas kolinergik berpengaruh terhadap keparahan dari Alzheimer Disease
5. Terjadi penurunan jumlah enzim kolin asetiltransferase di korteks serebral dan hipocampus menyebabkan penurunan sintesis asetilkolin di otak
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Diagnosis
• a detailed patient history
• information from family and friends
• physical and neurological exams and lab tests
• neuropsychological tests
• imaging tools such as CT scan, or magnetic resonance imaging (MRI). PET scans are used primarily for research purposes
• MMSE
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Tahapan Penurunan Kognitif Menurut MMSE
Mild
(MMSE score
26–18)
Difficulty remembering recent events, ability to manage finances, prepare
food, and carry out other household activities declines. May get lost while
driving. Begins to withdraw from difficult tasks and to give up hobbies.
Moderate
(MMSE score
17–10)
Patient requires assistance with activities of daily living. Frequently
disoriented with regard to time (date, year, season). Recall for recent
events is severely impaired. May forget some details of past life and names of
family and friends. Functioning may fluctuate from day to day. Patient
generally denies problems. May become suspicious or tearful. Loses ability to
drive safely. Agitation, paranoia, and delusions are common.
Severe
(MMSE score
9–0)
Patient loses ability to speak, walk, and feed self. Incontinent of urine and
feces. Requires care 24 hours a day and 7 days a week.
Mini Mental State Examination (MMSE)
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Gejala Alzheimer
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Tujuan Terapi
• Menjaga fungsi-fungsi pasien selama mungkin• Menunda perkembangan penyakit
Non farmakologi 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
Strategi Terapi
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Terapi Farmakologi
• inhibitor kolinesterase akan meningkatkan kadar asetilkolin (takrin, donepezil, rivastigmin, galantamin)
• Antagonis reseptor NMDA : Memantine• Antioksidan dapat memperlambat progresivitas
penyakit ( Vit E, selegilin (MAO inhibitor))• Alternatif terapi : ekstrak gingko biloba sebagai
neuroprotektif --- mengurangi kerapuhan kapiler, efek antioksidan, dan menghambat agregasi platelet tetapi masih perlu evidence yang lebih banyak.
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Terapi Berdasarkan Stage AD
• Mild - Moderate AD– Inhibitor Cholinesterase ( Donepezil,
Rivastigmin, Galantamine)
• Moderate - Severe AD– Antagonis NMDA (Memantine)
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Terapi simptomatik
Selain gejala gangguan kognitif juga terdapat gejala gangguan non kognitif seperti depresi,seperti gelisah, pelupa, dan insomnia
• Gejala depresi --- antidepresan (SSRI,TCA)• Insomnia --- perlu hipnotik, atau antidepresan
yang bersifat sedatif• Delusi --- curiga, menduga-duga yang salah,
paranoid --- antipsikotik (dicari yang paling kurang efek sampingnya) --- atipikal (klozapin, quetiapin, risperidon)
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THANK YOU ...