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ALZHEIMER
PEMBIMBING:dr.Marjanti,Sp.S
FathiaNurafatin
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Anatomi
Suunan ara! t"rdiri dari dua #a$ian :Suunan ara! "ntra%& puat :
'ta( #"ar )*"r"#rum+
'ta( ("i% )*"r"#"%%um+
Batan$ ota( )-runu "r"#ri+
Suunan ara! t"pi& p"ri!"r
Suunan ara! omati(
Suunan ara! otonom )impati dan
paraimpati+
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EFINISI
P"n/a(it A%0h"im"r ada%ahm"rupa(an $an$$uan !un$i (o$niti!/an$ on"tn/a %am#at dan $radua%,
degenerative,i!atn/a pro$r"i! danp"rman"n ,
M"rupa(an p"n/"#a# t"rjadin/a
d"m"ntia
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EPIEMI'L'GI
!a(tor r"i(o dari p"n/a(it A%0h"im"rada%ah umur /an$ tua dan poiti1"pada ri2a/at p"n/a(it ("%uar$a
M"napai "(itar 345647 daripopu%ai %"#ih dari 89 tahun
anita m"rupa(an !a(tor r"i(o$"nd"r /an$ %"#ih #"r"i(o t"rutama2anita uia %anjut
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Etio%o$i
Faktor Penyebab belunm diketahuisecara pasti akan tetepi terdapatbeberapa faktor resiko yaitu:
Fa(tor uia
Fa(tor ("turunan
;"ni ("%amin P"nurunan !un$i (o$niti!
Ga/a hidup
-in$(at P"ndidi(an
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B"rdaar(an 2a(tu munu%n/ap"n/a(it :
=.P"n/a(it A%0h"im"r on"t dini, /an$t"rjadi pada oran$ d"n$an uia di#a2ah >9 tahun, di"#ut ju$a
dementia pre"senile
3.P"n/a(it A%0h"im"r on"t %am#at )Lat"'n"t A%0h"im"r? i"a", L'A+,
#iaan/a t"rjadi pada oran$ uia diata >9 tahun, di"#ut ju$a seniledementia Alheimer!s #ype,
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Patofio%o$i
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Mani!"tai
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ia$noi
M"n"$a((an p"n/a(it A%0h"im"r o%"hthe $ational %nstitute of $eurologicaland &ommunicative Disorders and
Stroke)NIN*S+ dan the Alheimer!sDisease and 'elated Disorders
Association)ARA+
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M"n$$una(an (%aif(ai :
de(nite )dia$noi (%ini d"n$an$am#aran hito%o$i+
probable )indrom (%ini( tipi(a%tanpa $am#aran hito%o$i+
possible) $am#aran (%ini atipi(a%t"tapi tida( ada dia$noi a%t"rnati1"dan tida( ada $am#aran hito%o$i
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-ida( adan/a ("%inan it"mi( ataup"n/a(it ota( %ain /an$ dapat
m"n/"#a#(an d"fit pro$r"i! padam"mori dan (o$niti!
ia$noi pro#a#%" p"n/a(it A%0h"im"rdidu(un$ o%"h:
P"nurunan pro$r"i! !un$i (o$niti!p"if(
Gan$$uan a(ti1ita hidup "hari5hari
dan p"ru#ahan po%a p"ri%a(u Ri2a/at ("%uar$a d"n$an $an$$uan
/an$ ama,t"rutama #i%a udah
di(onfrmai "ara n"uropato%o$i
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-ida( adan/a tanda5tanda p"n/a(it%ainn/a
Bu(ti adan/a atrof ota( padap"m"ri(aan *- /an$ pro$r"i! dant"rdo(um"ntai o%"h p"m"ri(aan "ria%
Gam#aran (%ini %ain /an$ (onit"nd"n$an dia$noi pro#a#%" p"n/a(itA%0h"im"r:
P"rja%anan p"n/a(it /an$ pro$r"i!namun %am#at )p%at"au+
G"ja%a5$"ja%a /an$ #"rhu#un$an d"n$ana%0h"im"r
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A#norma%ita n"uro%o$i pada#"#"rapa pai"n
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i#uat #"rdaar(an adan/a $an$$uanota( atau it"mi( "(und"r /an$u(up untu( m"n/"#a#(and"m"nia,namun p"n/"#a# prim"rn/a#u(an m"rupa(an p"n/a#a# d"m"nia
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Stadium 1 Stadium 2 Stadium 3
M"mor/ : n"2 %"arnin$d"!"ti1", r"mot" r"a%%mi%d%/ impair"d
M"mor/ : r""nt andr"mot" r"a%% mor""1"r"%/ impair"d
Int"%"tua% !untion :"1"r"%/ d"t"riorat"d
iuopatia% (i%% :topo$raphidiori"ntation, pooromp%" ontrution
iuopatia% (i%% :patia% diori"ntation,poor ontrution
Lan$ua$" : poor2oord%it $"n"ration,
anomia
Lan$ua$" : Cu"ntaphaia
*a%u%ation :aa%u%ation
P/hiatr/ !"atur" :adn", or d"%ution inom"
P"rona%it/ :indiD"r"n", irrita#i%it/P/hiatr/ !"atur" :
d"%ution in om"
Sphint"r ontro% :urinar/ and !"a%
Motor /t"m : norma% Motor /t"m :r"t%"n", pain$
Motor /t"m : %im#ri$idit/ and C"ionpo"tur"
EEG : norma%
*-&MRI : norma%PE-&SPE*- : #i%at"ra%
EEG : %o2 #a($round
rh/thm*-&MRI : norma% or
EEG : diDu"%/ %o2
*-&MRI : 1"ntriu%ar andu%a% "n%ar$"m"nt
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P"m"ri(aan P"nunjan$
N"uropato%o$i
$euro(brillary #angles)NF-+
Senile Pla*ue)SP+ "$"n"rai n"uron
P"ru#ahan 1a(uo%"r
L"2/ #od/
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n"uropi(o%o$i(
Adan/a d"fit (o$nii /an$ #"rhu#un$an
d"n$an d"m"nia a2a% /an$ dapatdi("tahui #i%a t"rjadi p"ru#ahan rin$an/an$ t"rjadi a(i#at p"nuaan /an$ norma%.
m"m#"da(an ("%ainan (o$niti! pada$%o#a% d"m"nia d"n$an d"fit "%"(ti!/an$ dia(i#at(an o%"h di!un$i !o(a%,!a(tor m"ta#o%i(, dan $an$$uan pi(iatri.
M"n$id"ntif(ai $am#aran ("%ainann"uropi(o%o$i( /an$ dia(i#at(an o%"hd"m"nia (ar"na #"r#a$ai p"n/"#a#.
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-h" Mini5M"nta% Statu Eam )!rom Fo%t"in, MF, Fo%t"in, S and MHu$h, PR: Mini5m"nta% tat": a
pratia% m"thod !or $radin$ th" o$niti1" tat" o! pati"nt !or th" %ininian, ; P/hiatr R"
=3:=8@, =@9.+
Indi(ai
P"ni%aian ("mampuan (o$niti!
o(um"ntai p"nurunan ("mampuan (o$niti!
P"rtan/aan )-ota% 4 poin+
Kategori Poin Pertanyaan
'ri"ntai =4 -ahun, Muim, tan$$a%, hari, dan #u%an
N"$ara #a$ian, n"$ara, (ota
Rumah a(it atau (%ini(, %antai
R"$itrai Nama ti$a o#j"(: Ap"%, M"ja, uan$
S"tiap #"nda diuap(an p"r%ahan dan d"n$an j"da 2a(tu
Pai"n m"n$u%an$i "tiap #"nda /an$ diuap(an+
%an$i pro" hin$$a ("ti$a o#j"( dapat diin$at
*atat 2a(tu /an$ di#utuh(an untu( m"n$in$at ("ti$a #"nda
P h ti d 9
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P"rhatian dan
hitun$an
9 Eja 'RL dari arah #"%a(an$: LR'
Poin di#"ri(an pada "tiap huru! /an$ a%ah m"%"ta((an
*ontoh: L'R dihitun$ "#a$ai 3 poin aja
M"n/"#ut(an
("m#a%i )r"a%%+
%an$i pro" no.3 d"n$an ("ti$a o#j"( /an$ t"%ah diin$at.
Bahaa @ Pai"n m"m#"ri nama 3 #"nda
*ontoh: P"ni% dan ;am ) main$5main$ = poin+
%an$i (a%imat: No i! and or #ut
M"n$i(uti ti$a p"tunju( #"ri(ut:
Am#i% ("rta d"n$an tan$an (anan
Lipat m"njadi dua
Simpan di %antai
M"m#aa dan m"n$i(uti p"tunju(:
-utup matamu
-u%i "#uah (a%imat
M"n$(opi d"i$n
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ia$noa %ain #ia d"n$anm"n$$una(an (a%a "p"rti +lobal
Deterioritation Scale)GS+, "p"rti#"ri(ut:Tahap Kondisi Keterangan
= Norma%-ida( ada p"ru#ahan u#j"(ti! atau
o#j"(ti! da%am !un$i int"%"(tua%
3 Forgetfullness
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arly confusion
P"nurunan (o$niti! /an$
m"mp"n$aruhi p"("rjaan dan !un$i
oia%. Anomia, ("u%itan m"n$in$at(ata /an$ t"pat da%am p"ra(apan,
dan ("u%itan m"n$in$at /an$
ampai m"nari( p"rhatian ("%uar$a.
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9arly dementia
moderate AD/
Pai"n tida( dapat #"rtahan %ama
tanpa #antuan. S"rin$ diori"ntai
2a(tu )tan$$a%, tahun, muim+.
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>0iddle dementia
moderately severe AD/
Pai"n m"m#utuh(an p"rto%on$an
untu( m"%a(u(an a(ti1ita "hari5
hari )mandi, #"rpa(aian, (" toi%"t+,
("u%itan m"n$int"rpr"tai(an"("%i%in$n/a, %upa nama an$$ota
("%uar$a dan p"n$auhn/a, %upa
hampir "mua d"tai% ("hidupan
maa %a%un/a, u%it m"n$hitun$
mundur dari an$(a =4, a$itai,
paranoid, dan d"%ui )#"r(ha/a%+
-ate dementia
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*- San
m"%ihat (uantif(ai p"ru#ahan1o%um" jarin$an ota( pada p"nd"rita
Alheimerant"mort"m.
Atropi (orti(a% m"n/"%uruh danp"m#"aran 1"ntri("% ("duan/am"rupa(an $am#aran mar("rdominan /an$ an$at p"if( pada
p"n/a(it ini
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MRI
p"nin$(atan int"nita pada da"rah(orti(a% dan p"ri1"ntri(u%"r )*appin$ant"rior horn pada 1"ntri("% %at"ra%+.
MRI %"#ih "niti! untu( m"m#"da(and"m"nia dari p"n/a(itAlheimerd"n$an p"n/"#a# %ain, d"n$anm"mp"rhati(an u(uran )atropi+ dari
hipo(ampu.
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PE- )Positron mission #omography+
Pada p"nd"rita Alheimer, hai% PE-dit"mu(an p"nurunan a%iran darah,m"ta#o%im" '3, dan $%u(oa di
da"rah "r"#ra%
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ia$noi Bandin$
A%0h"im"r? i"a"
Frontot"mpora% "m"nti
"m"ntia 2ith L"2/ Bodi" *r"ut0!"%dt5;a(o# i"a"
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Farma(ot"rapi
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M"mantin
ntu( p"n$o#atan p"n/a(itA%0h"im"r "dan$ ampai #"rat.
oi a2a% untu( p"n$$unaan
M"mantin ada%ah 9 m$ p"rhari,("mudian doi ditin$(at(an#"rdaar(an p"n"%itian, hin$$a =4
m$ dua (a%i "hari
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Pai"n didia$no" A
;i(a tida( ada $an$$uanpi(iatri(
E1a%uai adan/a p"n/a(it %ain dan o#at /an$ m"mp"n$aruhi (o$niti!
Mod"ra"5"1"r"*hE inhi#itor,m"mantin,
atau (om#inai *hE%dan m"mantin 1it E
Mi%d*hE inhi#itor atauM"mantin 1it E
Sta#i%-"ru(an r"$im"n
p"n$o#atan
M"m#uru(B"ri(an a%t"rnati1" *hE
inhi#itor atau m"mantinit E
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Non Farma(ot"rapi
Buat%ah p"rmintaan dan p"rintahpada pai"n A%0h"im"r ""d"rhanamun$(in, dan hindari tu$a /an$ rumit/an$ dapat m"n/"#a#(an !rutai
Hindari (on!rontai dan p"no%a(an/an$ #ia m"n/"#a#(an !rutai
-"tap t"nan$, dan "%a%u m"ndu(un$
ji(a pai"n m"njadi an$atm"m#in$un$(an
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;a$a%ah (ondii %in$(un$an t"mpattin$$a% t"tap (onit"n dan hindari
p"ru#ahan /an$ tida( p"r%u S"dia(an a%at #antu untu(
m"n$in$at(an, m"nj"(%a(an, danm"nunju( arah pada pai"n A%0h"im"r
Sadari%ah p"nurunan (apaita dantin$(at(an harapan untu( p"r!ormanpai"n /an$ %"#ih #ai(
;i(a t"rjadi p"nurunan !un$i /an$ti#a5ti#a dan $"ja%a /an$ darurat,"$"ra #a2a (" t"na$a pro!"iona%
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P"n"$ahan S"rin$ m"%a(u(an ("$iatan /an$
m"%i#at(an ("mampuan (o$niti!.
P"n/a(it d"m"nia5a%0h"im"rm"n/"ran$ #a$ian ota( /an$m"n$atur !un$i (o$niti!. "n$an
%"#ih "rin$ m"%a(u(an ("$iatan /an$m"%i#at(an ("mampuan (o$niti!, a(an
"ma(in m"n$uran$i rii(o t"rjadin/ad"$"n"rai #a$ian ini
M"%a(u(an o%ah ra$a rin$an "#a$ai
a%ah atu po%a hidup "hat.
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Pro$noi
Ni%ai pro$noti( t"r$antun$ pada !a(tor/aitu:
"rajat #"ratn/a p"n/a(it
aria#i%ita $am#aran (%ini
P"r#"daan indi1idua% "p"rti uia,("%uar$a d"m"nia, dan j"ni ("%amin.
Pai"n m"mpun/ai an$(a harapan hiduprata5rata 65=4 tahun "udah dia$noidan #iaan/a m"nin$$a% dunia a(i#atin!"(i "(und"r
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