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Jumlah usia lanjut semakin meningkat
peningkatan masalah kesehatan terkait
meningkatnya usia
Salah satu masalah utama: penurunan fungsi
kognitif (ringan s.d. berat/demensia)
Selain faktor usia, beberapa faktor risiko vaskular
(DM, HT, dislipidemia, obesitas, dll) memudahkan
usila mengalami gangguan kognitif peran
SpPD penting
Perlu kesepahaman untuk menatalaksana usila
yang berisiko atau telah mengalami gangguan
kognitif ringan, agar tdk berlanjut menjadi
demensia yang berat
Gangguan Kognitif Ringan
Mild Cognitive Impairment (MCI)
Sindrom pre-demensia
Sebagian berlanjut menjadi demensia (terutama AD)
dengan laju progresi cukup tinggi
Stadium yang sesuai untuk intervensi terapi
Vascular Cognitive Impairment (VCI)
Penurunan fungsi kognitif ringan
Dihubungkan dengan iskemia/infark jaringan otak
akibat penyakit vaskular atau aterosklerosis
Keadaan prodromal timbulnya demensia vaskular
(VaD)
Progresi MCI Menjadi AD
Fungsi
kognitif
Penyakit Alzheimer
Umur
-1
Digit Symbol test score
10-year change on
-2
-3
-4
-5
Deterioration
-6
Swan.Swan. Neurology
Neurology. 1998;51:98693
1998;51:98693
DM and Risk of Dementia
(The Rotterdam Study)
30 - 27.0
Adjusted
difference 7.7%
20 - (95% CI 1.9% to
% Diabetes 15.0%); p 0.005
10.5
10 -
No dementia Dementia at
at follow up*, follow up*,
N=6244 N=126
*2.1 years of follow-up
40 -
No dementia Dementia at
at follow up*, follow up*,
N=8124 N=721
*30 years of follow-up
**Total serum cholesterol >240 mg/dL Whitmer et al. Neurology.2005;64:277-81
Direct effect of cardiovascular risk factors on the formation of
plaques and tangles and increased risk of dementia
Physical High High fat
inactivity BMI intake
Vascular
Smoking changes
ApoE4: poor
Neuronal Damage and repair
Degeneration
MCI VCI
AD VaD
Early detection
Advanced age
Risk factors (high BP, DM, high cholesterol,
obesity, history of stroke, family history, etc)
Memory complaint (usually short-term memory)
with intact activities of daily living, other cognitive
disfunction (execution, problem-solving, working
memory)
b
Subjects treated using insulin all have longer duration of
diabetes, worse control, and prevalence of hypoglycaemic attacks
All Subjects
Donepezil vs. placebo (HR, 95%CI): Vitamin E vs. placebo (HR, 95%CI):
First 12 mo 0.42 (0.24-0.76) First 12 mo 0.83 (0.52-1.32)
First 24 mo 0.64 (0.44-0.95) First 24 mo 0.95 (0.67-1.36)
All 36 mo 0.80 (0.57-1.13) All 36 mo 1.02 (0.74-1.41)
Vitamin E and Donepezil for the Treatment
of Mild Cognitive Impairment
Petersen et al. N Engl J Med. 2005;352:2379-88
APOE 4 Carriers
Donepezil vs. placebo (HR, 95%CI): Vitamin E vs. placebo (HR, 95%CI):
First 12 mo 0.34 (0.16-0.69) First 12 mo 0.78 (0.46-1.34)
First 24 mo 0.54 (0.35-0.86) First 24 mo 0.95 (0.64-1.41)
All 36 mo 0.66 (0.44-0.98) All 36 mo 0.95 (0.66-1.36)
Evidence of efficacy of donepezil for people with
mild or moderate vascular cognitive impairment
Malouf and Birks. The Cochrane Database of Systematic Reviews, 2005.
Authors conclusions:
Evidence from the available studies support the benefit of donepezil in
improving cognition function, clinical global impression and activities of daily
living in patients with probable or possible mild to moderate vascular cognitive
impairment after 6 months treatment.
Extending studies for longer periods would be desirable to establish the efficacy
of donepezil in patients with advanced stages of cognitive impairment.
Moreover, there is an urgent need for establishing specific clinical diagnostic
criteria and rating scales for vascular cognitive impairment.
Peran Dokter Spesialis Penyakit Dalam
Optimalisasi
pengelolaan
Evaluasi fungsi kognitif dengan MMSE FOLSTEIN faktor risiko
KONSENSUS NASIONAL
Peran Dokter Spesialis Penyakit Dalam untuk
Deteksi Dini, Diagnosis, dan Penatalaksanaan
Gangguan Kognitif Ringan pada Usia Lanjut
ALGORITME (LANJUTAN)