Demensia
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![Page 1: Demensia](https://reader035.fdokumen.com/reader035/viewer/2022071718/55cf99fc550346d0339ffef9/html5/thumbnails/1.jpg)
DEMENSIA
Dr.FX.Soetedjo Widjojo, SpSLab/SMF.Ilmu Penyakit SarafFK.UNS/RSUD.Dr.Moewardi
Surakarta
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Demensia
Sindroma penurunan fungsi kognisi yang dapat bermanifestasi sebagai gangguan memori, disertai dua atau lebih domain kognitif lainnya (atensi, bahasa, praksis, orientasi dan fungsi eksekutif) yang cukup berat sehingga menyebabkan gangguan aktifitas harian yang dibuktikan dengan pemeriksaan klinik dan tes neuropsikologi
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Etiologi Demensia• Tak diketahui
- Alzheimer• Degeneratif
- Parkinson disease- Khorea Huntington- Demensia Lewy Bodies
• Infeksi- Creutfeldts Jacob Disease- AIDS- Neurolues
• Normal Pressure Hydrocephalus• Trauma
- Trauma kepala- Demensia Pugilistica- Subdural Hematom
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Etiologi Demensia
• Pseudo Demensia- Depresi
• Nutrisi- Sindroma Wernicke Korsakoff- Defisiensi vit. B12- Defisiensi Asfolat- Alkoholism
• Metabolik- Hipoglikemia lama- Hipotiroidism- Sindroma Cushing
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Etiologi Demensia
• Vaskuler- Demensia multi infark- Binswanger’s disease
• Gagal Organ- Demensia dialisis- Wilson’s disease
• Tumor- Meningioma sub frontal- Tumor otak
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Mudah Lupa (Forget Fullness)
• Penurunan fisiologis kemampuan otak• Gangguan pemusatan
perhatian/konsentrasi• Mengabaikan hal – hal tak penting• Butuh waktu lama belajar hal baru
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MCI (Mild Cognitive Impairment)
• Gangguan memori jangka pendek• Aktivitas harian normal• Tanda demensia -• Tiap TH 12% Demensia Alzheimer
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Demensia Alzheimer
• Progresif• Gangguan memori• Aphasia• Apraksia• Agnosia• Gangguan fungsi eksekutif
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Demensia Alzheimer
• Gangguan belajar• Menyimpan informasi baru• Gangguan spasial dan orientasi• Gangguan berbahasa/komunikasi• Sulit menangani tugas komplek• Tak mampu memecahkan masalah• Perubahan perilaku
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Demensia Vaskuler
• 10 – 20%• Perburukan kognisi mendadak/
fluktuatif dalam waktu 3 bulan post stroke
• Defisit neurologik fokal• Faktor resiko stroke +• CT Scan stroke
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Vad AD
Awitan Mendadak/gradual Gradual
Progresifitas Bertahap/fluktuasi Kontinu
GAIT Terganggu stad dini Normal sampai
stad lanjut
Kondisi Faktor resiko Jarang
Kardiovaskuler
Kardiovaskuler Stroke/TIA -/+ pada type
campuran
Neurologis Defisit fokal -
Neuroimaging Infark multiple normal/atropi
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Demensia Lewy Body
• Gangguan memori lebih ringan• Sindroma Parkinson dalam 1
tahun• Halusinasi visual• Gangguan fungsi eksekutif• Fungsi kognisi progresif
mengganggu fungsi sosial (atensi)
• Ada Lewy Body di Neo kortek
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Demensia Fronto Temporal (FTD)
• Usia 50 – 60 th• Awal gangguan fungsi bahasa
(Afasia)• Disinhibisi, Perseverasi, Stereofipi• Gangguan kepribadian sering
menonjol sejak dini• Gangguan memori lebih ringan• Atrofi fronto temporal
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Parkinson Disease• 30% Demensia• Halusinasi –• Kepekaan antipsikotik –• Fluktuasi kognisi –
Khorea HuntingtonDiturunkan otosom dominan Motorik korea, distonia & Parkinsonism Gangguan gerak bola mata, disartria,disfagia, disfungsi eksekutif, depresi berat
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Normal Pressure HydrocephalusTrias demensia, ataksia,inkontinensiaurineGangguan memoriCT Scan : HidrosefalusTerapi : Ventrikulo peritoneal shunt
Subdural Hematom Kronik :Nyeri kepalaHemiparesisCT Scan : perdarahan subdural
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Creutzfeldt Jacob Disease
• Progresif pada 60 – 70 th• Piramidal, ekstrapiramidal, cerebellar dan
mioklonus• EEG spesifik : sharp wave complex
Demensia HIV – AIDS- Depresi – apati – konsentrasi buruk
gangguan memori jangka pendek- Unsteady gait, extremitas lambat, tremor- Tahap lanjut afasia & mutism- CT Scan/MRI : lesi substansia Alba
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Neurolues :Psikosis, TremorPupilargyl RobertsonTabes Dorsalis, UDRL +
Tumor otak : Tanda – tanda TIK (nyeri kepala, papiledema, muntah – muntah)Defisit Neurologis Fokal
Pseudo Demensia (Depresi)Anoreksia – kurus – murungInsomniaNiat bunuh diri
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Pemeriksaan Penunjang- HCT, MCU B12 - Fungsi hati- B1 - HIV- As folat - TPHA, UDRL- Fungsi Tiroid - Glukosa- Fungsi ginjalLCS : Sitologi, UDRLCT Scan/MRI : Tumor otak SDH kronik Multi Infark Normal Pressure HydrocephalusEEG : Creutzfeldts Disease