GANGGUAN FUNGSI

LUHUR
(NEUROBEHAVIOR)
 Pendahulua
n

Selain berhubungan dengan gerakan, sensasi dan

organ sensorik spesifik, korteks merupakan
substrat untuk fungsi komprehensi, kognisi dan
komunikasi

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Stimulus Integrasi Respon

Integrasi semua impuls

afferen pada korteks sereb

Gangguan berupa: Bila terjadi ggn integrasi ,

1. Ggn orientasi terjadi :
2. Ggn ingatan Gangguan fungsi luhur
3. Ggn intelegensia (Gangguan fungsi kortikal
4. Ggn kendali diri (Gangguan kualitas kesada
5. Ggn pertimbangan
BERBAHASA DAN BICARA

Fasikulus arcuata
jaras asosiasi dalam
white matter
hubungkan area
Wernicke dan Broca

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AFASIA Gangguan
berbahasa akibat
kerusakan otak

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Afasia tanpa gangguan pengulangan

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Aleksia Ketidakmampuan untuk
membaca sbg bgn
sindroma afasia atau
sebagai abnormalitas

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 Kesulitan dalam pengenalan
Agnosia dan identifikasi objek
Biasanya disebabkan
gangguan pada fungsi asosiasi
korteks serebri

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 Ketidakmampuan melakukan aktivitas
Apraksia motorik secara benar, meskipun jaras
motorik dan sensorik utuh, dan
pemahaman baik

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 DEMENSIA

Dementia is an
acquired loss of
cognitive function
due to an abnormal
brain condition.

UISU 2011-2
DEMENSIA

Minimal melibatkan gangguan

2 fs berikut :
MEMORI + bahasa
fs visuospasial
kalkulasi
judgement
berpikir abstrak
problem solving
skills

UISU 2011-2
 WHAT ARE THE CAUSES ??
COMMON CAUSES :
Alzheimers disease, multi infarct or
vascular dementia , Lewy body dementia,
pseudodementia.
UNCOMMON CAUSES :
toxins, vitamin deficiencies, endocrine
disturbances, chronic metabolic
conditions, vasculopathies of the brain,
structural abnormalities, CNS infections
UISU 2011-2
Alzheimers Disease
UISU 2011-2
UISU 2011-2
 DEMENSIA ALZHEIMER

Dulu : Dx
berdasarkan otopsi
Sekarang :
klinis +
pemeriksaan
penunjang
akurasi 85 - 95%

UISU 2011-2
 Neuropathologic changes
characteristic of Alzheimers disease
(AD)
Normal AD

AP NFT

AP=amyloid plaques
NFT=neurofibrillary tangles Courtesy of Grossberg G, St. Louis2011-2
UISU University
PROSEDUR DIAGNOSTIK

SKRINING :
Anamnesa riwayat perjalanan penyakit
Test psikometrik/neuropsikologis
DIAGNOSTIK :
Konfirmasi (neurolog, psikiater,
geriatrist)
Pemeriksaan penunjang (lab, radiologi,
dll)
Rencana penatalakasanaan
UISU 2011-2
UISU 2011-2
Who is going to be screened ??

Screening for
cognitive impairment
among
asymptomatic
persons is not
recommended

(WHO Technical Report Series

730)

UISU 2011-2
 SCREENING INSTRUMENTS

Mini Mental State Examination (MMSE)

Clock Drawing Test
Functional Activities Questionnaires (FAQ)
Geriatric Depression Scale
Ischemic Hachinski Score

UISU 2011-2
 CLOCK DRAWING TEST

To assess :
Executive functions(frontal lobe)
Visuospatial (parietal lobe)
Method :
Ask the patient to draw a clock
Place the numbers in correct place
Ask the patients to draw clock hands
that
shows ten minutes pass eleven

UISU 2011-2
 CLOCK DRAWING TEST (cont.d)

Lingkaran Sko
tertutup r1
Meletakkan angka Sko
pada posisi yang r 1
benar
Memasukkan Sko
semua angka 12 r1
Meletakkan jarum Sko
pada posisi yang r1
benar
UISU 2011-2
 Examples of Clock Drawing

Adequate clock Reversed numerals

& incorrect hand
UISU 2011-2
placement.
UISU 2011-2
 Diagnosing AD
There is currently no single test that
accurately diagnoses Alzheimer's disease, so
doctors use a variety of assessments and
laboratory measurements to make a diagnosis

Medical history

Physical examination
Standard laboratory tests

Neuropsychological testing
Brain-imaging scan
UISU 2011-2
 NINCDS-ADRDA Alzheimer's
Criteria
Definite Alzheimer's disease:
probable Alzheimer's disease + histopathologic evidence
of AD via autopsy or biopsy.
Probable Alzheimer's disease:
established by clinical and neuropsychological
examination. Cognitive impairments also have to be
progressive and be present in two or more areas of
cognition.
Possible Alzheimer's disease:
dementia syndrome with an atypical onset, presentation
or progression; and without a known etiology; but no co-
morbid diseases capable of producing dementia are
believed to be in the origin of it.
Unlikely Alzheimer's disease:
dementia syndrome with a sudden onset, focal neurologic
signs, or seizures or gait disturbance early in the course of
the illness.
UISU 2011-2
 MANAGEMENT OF AD

Managing the
family
Managing the
environment
Managing the
patient

UISU 2011-2
 NON PHARMACOLOGICAL
TREATMENT
Train and support the family or
caregiver
Environment intervention : physical,
temporal, sleep hygiene, deficits
controlling, balance and healthy diet
Behavior management : specific
adaptation and modification for
every single case.
UISU 2011-2
 PHARMACOLOGICAL TREATMENT
OF AD
DRUGS MECHANISM OF ACTION
choline, lecithine precursor loading
besipirdine, linopirdine neurotransmitter release

tacrine, donepezil AchE transferase inhibitor

rivastigmine, galanthamine

milameline, talsaclidine muscarinic agonists

Xanomeline

Memantine NMDA receptor antagonist

UISU 2011-2
TERIMAKASIH

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