ALZHEIMER

Jessi S
Setiawan
WHO th 1980-2025:
Penduduk dunia 2 kali lipat
Manula th 2000 : 7,28%
2020 : 11,34%
UHH th 2000 : 70,4
Indonesia 1990-2025 : manula meningkat 414%
Demensia 5 – 11 % > 65 thn
50 % > 85 thn
Alzheimer th 2000 : 4 juta
th 2040 : 14 juta
• Amnesia berat : tdk kenal diri, kel, orang.
• Afasia berat : Global – mutisme.
• Apraxia berat : tdk dpt makan, minum, ADL
hilang.
• Insomnia, hipersomnia.
• Inkontinen urine / faeses.
Parkinson
• Terjadi jika neuron pada otak, substantia
nigra rusak. Sel substansia nigra
memproduksi hormon dopamine yang
mengkoordinasi gerakan dan menghaluskan
gerakan otot rangka.
 Etiologi
1. Usia & matinya neuron penghasil
dopamin
2. Lingkungan : pestisida, logam berat,
CO
3. Trauma
4. Genetik
Stadium awal:
• Lemah, sakit, malaise.
• 70% pasien dengan tremor ringan pada
tangan atau kaki pada satu sisi tubuh.
• Kekakuan otot dan imobilitas dari tangan.
• Kelemahan otot wajah dan tenggorokan shg
pasien susah menelan, dan bicara.
• Kekakuan otot wajah shg ekspresi wajah
kaku.
• Instabilitas postur.
• Susah berjalan, risiko jatuh meningkat.
• Peningkatan produksi saliva
• Melemahnya volume, kecepatan suara,
suara menjadi gagap.
• Bradykinesia (slow movement)
• Meningkat dan meluasnya tremor ke seluruh
ekstremitas.
There are six categories of medications
for PD:
1. Levodopa (most potent & last prescribed)
2. Dopamine Agonists
3. COMT (Catechol-Ortho-Methyl
Transferase) Inhibitors
4. MAO (Mono Amine Oxidase) Inhibitors
{uses first}
5. Amantadine {used first}
6. Anticholinergics
TRIGEMINAL
NEURALGIA
 “Tic Doloureau”
• 4.3 per 100,000
• Slight female predominance : 1.74 t0 1
• Peak incidence 60-70 y.o.
• Unusual before age 40
• No racial prediliction
 Spontaneous remission possible, BUT unusual
 Most patients will have episodic attacks over
many years
 Etiology
• Exact cause unknown
• Maxillary and mandibular sensory branches
affected
• Four Theories
-Constant pressure causing irritation from the
superior cerebellar artery
- infections from herpes virus, teeth, or brainstem
infarct
-Multiple Sclerosis
-Tumor causing pressure and irritation
 Pathophysiology
• Demyelination of the trigeminal nerve, causing
ectopic impulses and then ephaptic conduction
• Vascular compression of the nerve root
• Compression by tumor
• Amyloid
• A-V malformation
• Pons Infarct
• Bony compression
 Diagnosis
- Consider in all patients with unilateral facial pain
• “Rule-out” process
-CT: lesions or vascular abnormalities
-Lumbar puncture & MRI
• Complete neurologic assessment
• Audiologic evaluation
-results usually normal
• Other r/o pathologic conditions
-EMG (electromyography)
-cerebrospinal fluid analysis
-arteriography
-myelography
 Diagnostic History
• Very important
• Recurrent, unilateral facial pain
• Lasts seconds
• May recur 100’s of times per day
• Pain :
– Severe Stereotypical
– Sharp Stabbing
– Superficial Shock-like
 1 or more of the nerve’s divisions
 Trigger factors:
 Talking Shaving
 Smiling Applying make-up
 Chewing Wind
 Teeth brushing
 Age > 40 yrs.
 Ask about other neuro Sx
 Asymptomatic time or not ?
 Treatment
• Medical
• Surgical
• No Behavioral, unless it becomes a cause of
Chronic Pain
 Prognosis
• Not life threatening but very disabling
• Corrected completely or reduced and
managed with treatment
• Medication therapy
-Antiseizure medications
*Carbamazepine , Phenytoin, valproate
-Newer Antiseizure medications
*Oxcarbazepine, Gabapentin
-Muscle relaxants
 Conservative/Surgery Therapy
• Conservative
-Nerve blocking with local anesthetics
-Biofeedback
• Surgery
-Microvascular Decompression (MVD)
-Radiofrequency rhizotomy
-Gamma knife radiosurgery
-Retrogasserian rhizotomy
-Suboccipital craniotomy
-Glycerol rhizotomy
 Trigeminal Neuralgia Diet
• Low fat, high protein, high calorie
• Easy chewable foods
• Served lukewarm
• Offered frequently
• Individual basis d/t different triggers, culture
religious preferences
• Trigeminal Neuralgia Association recommends
-avoidance of: extreme hot/cold
hot sauce, chili, spicy salsa, mints
black pepper, cinnamon, ginger
• No effect on bladder/bowl function
 Nursing Care
• PAIN MANAGEMENT
-suicidal tendencies d/t severity
• Provide dark room with moderate temp/ no drafts/
private room
• Assess triggers for prevention
• Do not touch the face
• Alternative ways of communication
• Psychosocial huge!!!
-lifestyle/interaction with others/employment
• Increase of illegal and prescription drug use
• NG tube on unaffected side for nutrition intake
Thank
You