MCI BLOK 16.ppt

8/12/2019 MCI BLOK 16.ppt

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M

C

I

inimal

ognitive

mpairmentsyafruddin yunus


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2 Neurological Function

1. Hard neurological Functunction

Walking,Talking, hearing, balancing,

urine, eating, etc

2. Soft neurological function

neurobehavioural function ( languange,memory, visuospatial, atention, cognitive)


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4

STIMULUS INTRINSIK / EKSTRINSIK

FUNGSI LUHUR

SDMKUALITAS

IPTEK / IMTAK

DERAJAT MAHLUK

SURVIVAL

PENDAHULUAN


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5

Mahar Mardjono:FL adalah suatu fungs i pada manus ia

yang mengolah dan mengintegrasikanpersepsi secara adekwat

Lezak : . Is an applied science concerned with

the behaviou ral expressiono f brain dy sfunct ion

DEFINISI


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Cognitive Function

The best function of neurobehaviour

Sublimation of other neurobehaviour

function

Excecutive functions ; thinking, opinion,

manajemen, solving the problems, wise,

human quality.


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Introduction

MCI is a phase of brain decline

High risk of developing Alzheimer (type

dementia )

No uniform definition

Prevalence ; 2 -30% in general population

( Indonesia : no data ) General concept ; cognitive impairment

but not demented.


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BRAIN DECLINE SEQUENTIAL

IN ELDERLY

SENESCENCE ( Fisiological )

SENILITY ( In-between group)

DEMENTIA ( Pathological)


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SENESCENCE ( Fisiologis)

Signed by forgetfulness.

Kral (1958) : Benign Senescent Forgetfulness (BSF)Crook (1986) :Age Associated Memory Impairment

(AAMI)

Prevalence :

35% in > 65 th age (Lane& Snowdown 1989)

39% in 59 - 60 th & 85% in >80 th age

(Larabe & Crook 1994)


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DEMENTIA ( Pathological )

Signed by minimal 3 neurobehavior functionimpairment ( 5 )

Predominant memory impairment

Demented

Ironic : Demented is usual in elderly Is a medical illness


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SENILITY ( In-between group)

Signed by actual memory impairment withoutdemented

Mild Cognitive Disorder (MCD) 1993, ICD 10 WHO

Mild Neuro Cognitive Disorder (MNCD) 1994, Levy

Cognitive Impaired Not-Demented (CIND) 1995,Ebly

Mild Conitive Impairment (MCI)1996, Smith


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Definition and terminology

Operationalized : the presence of cognitiveimpairment that is not severe enough to meetthe criteria of dementia

More than 40 definitions (2004)

6 major concepts based on : Cognitive complaints only

Mild functional impairment only

Cognitive tests impairment only

Combination of cognitive & tests impairment Combination mild functional & tests impairment

Mild functional tests impairment


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MINIMAL COGNITIVE IMPAIRMENT( M.C.I )

Reported for the first time in 1999 in Mayo Clinic

is a trantition phase to dementia

12% in a year , 50% in 3 years ,

80% in 8 yearsCriteria :

- There is an actual memory impairment

reported by another person

- Abnormal impairment for age and education

- Normal ADL

- General cognitive function is normal

- Not demented


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NEUROPATHOLOGy/PATHOGENESIS

Brain organic disorders : frontotemporal lobe

atrophy

Microscopic : depend on underlying disease

AlzheimerDementia : senile plaque - neurofibrile

tangles - neuronal loss.

Blood ; amyloid protein,tau protein

Neurotransmiter : Ach preparing disorder

Alzheimer Dementia : Ach


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Causes of MCI

Similarly with Alzheimer dementia

MCI is a phase in continuum to Alzheimer


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Diagnostic

Clinical sign & symptoms ( neurobehaviorfunction )

Examination

Neurological Supporting examination

Neuropsikiatric tests MMSE, GDS

Radiology

Imaging

Biochemical ( tau protein , Beta amyloid)


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NORMATIVE

AGINGM C I

DEMENTIAPATO.AGING

MMSE >24

GDS 1

MMSE 23-17

GDS 2

CONTINUUM

DEGRADASI KONDISI USILA

MMSE


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Jenis Tatalaksana

NON FARMAKOLOGIS

FARMAKOLOGIS

Psikososial

Stimulasi Kognisi

- Terapi rekreatif

= Reminisens

= Orientasi nyata

Latihan fisik & otak

ChE-I

Nootropik

Neuroprotektiv

NSAID

Estrogen

Simptomatik lain


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Conclusion

MCI is a heterogenous condition

MCI is the risk for Alzheimer ( type dementia)

No standard criteria for MCI

MCI is not related to one spesific disorder

Combination of variable examination may be

useful to diagnose MCI

MCI should be considered as a syndome ratherthan as a disease

The treatment in this phase is very benefit


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MCI BLOK 16.ppt

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