Dementia

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DEMENSIA
Demensia bukanlah penyakit spesisik. Demensia digambarkan sebagai kumpulan gejala yang disebabkan oleh banyaknya gangguan yang berakibat pada otak. Orang dengan demnsia mengalami kerusakan fungsi intelektual yang signifikan yang berhubungan dengan aktiftas normal serta hubungan antar manusia. Orang yang menderita demensia juga kehilangan kemampuan untuk menyelesaikan masalah dan mengontrol emosi. Dan mengalami perubahan kepribadian dan memiliki masalah perilaku seperti agitasi, delusi, dan halusinasi. Ketika kehilangan memori menjadi gejala umum demensia tetapi bukan berarti orang yang mengalami kehilangan memori dikataka demensia. Dokter aka mendiagnosa seseorang mengalami demensia hanya jika 2 atau lebih fungsi otak seperti memori, kemampuan bicara, persepsi atau kemampuan kognitif mencakup membuat alasan daa membuat keputusan secara bermakna menjadi terganggu tanpa kehilangan kesadaran. Banyak gangguan yang dapat menyebabkan demensia. Seperti penyakit alzeimer, yang menimbulkan kehilangan fungsi mental yang progresif. ada penyakit demensia yang disebabkan alzeimer dan penyakit demensia lainnya, proses penyakit menyebabkan banyak sel saraf yang berhenti berfungsi, kehilangan koneksi dengan neuron lainnya, dan akhirnya terjadi kematian sel saraf. Secara jelas proses penuaan yang normal tidak menimbulkan kehilangan fungsi neuron otak. Demensia ! istilah umum yang digunakan untuk menggambarkan kerusakan fungsi kognitif global yang biasanya bersifat progresif dan memengaruhi aktifitas sosial dan okupasi yang normal juga aktifitas kehidupan sehari hari "#KS$ enyakit penyakit yang meningkatkan gejala demensia ! % % enyakit alzeimer % Demensia multiinfark

Bentuk bentuk Demensia.
&angguan demensia dapat dikelompokkan dengan banyak cara berbeda. Berikut beberapa klasifikasi umum yang biasa digunakan. % Cortical dementia : demensia yang disebabkan kerusakan utama pada bagian korteks otak. #tau lapisan pada korteks yang menimbulkan masalah pada memori, bahasa, berfikir, dan perilaku sosial. % Subcortical dementia: demensia yang disebabkan kerusakan utama pada bagian ba'ah korteks, yang menyebabkan perubahan emosi dan pergerakan yang menambah masalah pada memori. % Progressive dementia / demensia rogresi!: demensia yang memburuk setia 'aktu, berhubungan dengan kemampuan kognitif.

% Primar" dementia / demensia dasar : demensia yang terjadi pada penyakit alzeimer yang tidak ditimbulkan oleh penyakit lain. % Secondar" dementia / demensia sekunder: demensia yang terjadi sebagai hasil dari penyakit fisik atau kecelekaan.

DEMENSIA DAN #$N%SI &'A(
Defenisi ! Demensia ialah kondisi keruntuhan kemampuan intelek yang progresif setelah mencapai pertumbuhan ( perkembangan tertinggi "umur )* tahun$ karena gangguan otak organik, diikuti keruntuhan perilaku dan kepribadian, dimanifestasikan dalam bentuk gangguan fungsi kognitif seperti memori, orientasi, rasa hati dan pembentukan pikiran konseptual. Biasanya kondisi ini tidak re+ersibel, sebaliknya progresif. Diagnosis dilaksanakan dengan pemeriksaan klinis, laboratorlum dan pemeriksaan pencitraan "imaging$, dimaksudkan untuk mencari penyebab yang bisa diobati. engobatan biasanya hanya suportif. Demensia bisa terjadi pada setiap umur, tetapi lebih banyak pada lanjut usia " *, untuk rentang umur -*./0 tahun dan 01, bagi yang berumur 23* tahun$. Kebanyakan mereka dira'at dalam panti dan menempati sejumlah *1, tempat tidur. 4tiologi dan klasifikasi 5 6enurut 7mur! ). Demensia senilis "2-*th$ 2. Demensia prasenilis "8-*th$ 5 6enurut perjalanan penyakit! % 9e+ersibel % :re+ersibel ";ormal pressure hydrocephalus, subdural hematoma, +it B Defisiensi, <ipotiroidisma, into=ikasi b. 5 6enurut kerusakan struktur otak >ipe #lzheimer ). >ipe non.#lzheimer 2. Demensia +askular ?. Demensia @isim Ae'y "Ae'y Body dementia$ 0. Demensia Aobus frontal.temporal *. Demensia terkait dengan S:D#"<:B.#:DS$ -. 6orbus arkinson /. 6orbus <untington

3. 6orbus ick C. 6orbus @akob.Dreutzfeldt )1. Sindrom &erstmann.StrEussler.Scheinker )). rion disease )2. alsi Supranuklear progresif )?. 6ultiple sklerosis )0. ;eurosifilis )*. >ipe campuran 5 6enurut sifat klinis! o Demensia proprius o seudo.demensia >anda dan gejala 5 Seluruh jajaran fungsi kognitif rusak. 5 #'alnya gangguan daya ingat jangka pendek. 5 &angguan kepribadian dan perilaku, mood s'ings 5 Defisit neurologik motor ( fokal 5 6udah tersinggung, bermusuhan, agitasi dan kejang 5 &angguan psikotik! halusinasi, ilusi, 'aham ( paranoia 5 #gnosia, apra=ia, afasia 5 #DA "#cti+ities of Daily Ai+ing$susah 5 Kesulitan mengatur penggunaan keuangan 5 >idak bisa pulang ke rumah bila bepergian 5 Aupa meletakkan barang penting 5 Sulit mandi, makan, berpakaian, toileting 5 asien bisa berjalan jauh dari rumah dan tak bisa pulang 5 6udah terjatuh, keseimbangan buruk 5 #khirnya lumpuh, inkontinensia urine ( al+i 5 >ak dapat makan dan menelan 5 Koma dan kematian Diagnosis Diagnosis difokuskan pada ? hal! 5 embedaan antara delirium dan demensia 5 Bagian otak yang terkena 5 enyebab yang potensial re+ersibel 5 erlu pembedaan dan depresi "ini bisa diobati relatif mudah$ 5 emeriksaan untuk mengingat ? benda yg disebut 5 6engelompokkan benda, he'an dan alat dengan susah payah 5 emeriksaan laboratonium, pemeriksaan 44D 5 encitraan otak amat penting D> atau 69:

>erapi ertama perlu diperhatikan keselamatan pasien, lingkungan dibuat senyaman mungkin, dan bantuan pengasuh perlu. 5 Koridor tempat jalan, tangga, meja kursi tempat barang keperkuannya 5 >idak diperbolehkan memindahkan mobil dsb. 5 Diberi keperluan yang mudah dilihat, penerangan lampu terang, jam dinding besar, tanggalan yang angkanya besar Beha+ioural and sychological Symptoms of Dementia "B SD$ B SD perlu dibahas di sini karena merupakan satu akibat yang merepotkan bagi pengasuh dan membuat payah bagi sang pasien karena ulahnya yang amat mengganggu! Beha+ioural &angguan perilaku 5 agitasi 5 hiperaktif 5 Keluyuran o erilaku yang tak adekuat o #bulia kognitif o #gresi F +erbal, teriak F fisik 5 &angguan nafsu makan o &angguan ritme diurnal F >idurGbangun o erilaku tak sopan "social$ F erilaku se=ual tak sopan F De+iasi se=ual F iromania sychological 5 &angguan afektif o #n=ietas o lritabilitas o &ejala depresif. o Depresi berat 5 Aabilitas emosional o #pati o Sindrom 'aham ( salah.identifikasi F Orang menyembunyikan dan mencuri barangnya F paranoid, curiga o 9umah lama dianggap bukan rumahnya o asangan G pengasuh F alsu

F >ak setia F 6enelantarkan pasien F Demburu patologik F KeluargaGkenalan yang mati masih hidup o <alusinasi F Bisual F #uditorik F Olfaktoriik F 9aba "haptik$

)*at &t*er Conditions Can Cause Dementia+
KO;D:S: A#:; H#;& D# #> 64;H4B#BK#; D464;S:# Banyak kondisi lain yang dapat menyebabkan demensia atau gejala mirip demensia. ,eaksi engobatan. engobatan kadang dapat menimbulkan reaksi atau efek samping berupa mimic dementia. 4fek mirip demensia ini dapat terjadi sebagai reaksi terhadap satu obat atau dapat terjadi karena interaksi obat. Demensia tipe ini dapat terjadi secara cepat tapi berkembang lambat. Masala* Metabolik dan Abnormalitas Endokrin. 6asalah tiroid dapat menimbulkan masalah apatis, depresi, atau demensia. <ipoglikemia, dapat menyebabkan kebingungan atau perubahan kepribadian. Kekurangan atau kelebihan sodium atau kalsium juga dapat memacu perubahan mental. >oo little or too much sodium or calcium can also trigger mental changes. >erkadang kondisi anemia pernisiosa yang disebabkan karena gangguan penyerapan +itamin B )2 juga dapat menimbulkan perubahan kepribadian, iritabilitas, atau depresi. De!isiensi Nutrisi. Defisiensi tiamin "+it. B)$ yang biasa terjadi pada alkoholik cronis juga dapat mengalami gangguan kemampuan mental yang serius terhadap ingatan tertentu dari suatu kejadian. Defisiensi berat +itamin B- dapat menyebabkan dapat menyebabkan penyakit neurologis yang disebut pellagra yang juga termasuk dalam demensia. In!eksi. Banyak infeksi yang dapat menyebabkan gejala neurologis, mencakup konfusi atau delirium, yang berhubungan dengan demam. 6eningitis, ensefalitis dapat menyebabkan konfusi, demensia berat secara tiba tiba., menjauh dari interaksi sosial, atau kehilangan memori. Sifilis yang tidak diobai juga dapat merusak sistem saraf dan menyebabkan demensia. 7ntreated syphilis also can damage the ner+ous system and cause dementia. Dalam beberapa kasus yang langka orang dengan #:DS tingkat lanjut juga dapat mengalami demensia. Orang dengan sistem imun yang tertekan seperti leuikimia dan #:DS, juga infeksi yang disebut Aeukoensepalopati 6ultifokal rogresif yang disebabkan oleh polioma+irus, dapat menimbulkan kerusakan atau penghancuran selubung 6ielin yang menutupi sel saraf., sehingga akhirnya kondisi ini menimbulkan konfusi, kesulitan berfikir atau berbicara, dan gangguan mental lainnya. . (eracunan. aparan terhadap logam berat atau bahan beracun lainnya dapat menimbulkan gejala demensia. &ejala ini mungkin dapat atau mungkin tidak dapat diperbaiki setelah pengobatan, tergantung seberapa berat kerusakan yang terjadi. Orang

dengan penyalahgunaan alkohol dan obat obatan menunjukkan gejala demensia yang terjadi setelah penyalahgunaan obat dihentikan. Kondisi ini disebut sebagai demensia yang timbul karena bahan beracun. 'umor &tak. Dalam kasus yang langka, orang dengan tumor otak mengalami demensia karena kerusakan otak mereka. &ejala mencakup perubahan kepribadian, episode psikosis, atau gangguan bicara bahasa, berfikir, dan memori. Anoksia. #noksia atau istilah yang berhubungan seperti <ipoksia. Setelah proses penyembuhan terjadi kelainan neurologis dan psikologis seperti demensia atau psikosis mungkin terjadi, diamana orang tersebut. Orang tersebut juga mengalami konfusi, perubahan kepribadian, halusinasi serta kehilangan memori. Masala* -antung Dan Paru . Otak membutuhkan oksigen tingkat tinggi yang membuatnya bekerja normal. Karena itulah, masalah seperti penyakit paru kronik atau masalah pada jantung yang mencegah otak menerima oksigen adekuat dapat menyebabkan sel otak mengalami kekurangan oksiegn dan menimbulkan masalah demensia.

)*at Conditions Are Not Dementia+
Age.related cognitive decline. #s people age, they usually e=perience slo'er information processing and mild memory impairment. :n addition, their brains freIuently decrease in +olume and some ner+e cells, or neurons, are lost. >hese changes, called age. related cogniti+e decline, are normal and are not considered signs of dementia. Mild cognitive im airment. Some people de+elop cogniti+e and memory problems that are not se+ere enough to be diagnosed as dementia but are more pronounced than the cogniti+e changes associated 'ith normal aging. >his condition is called mild cogniti+e impairment. #lthough many patients 'ith this condition later de+elop dementia, some do not. 6any researchers are studying mild cogniti+e impairment to find 'ays to treat it or pre+ent it from progressing to dementia. De ression. eople 'ith depression are freIuently passi+e or unresponsi+e, and they may appear slo', confused, or forgetful. Other emotional problems can also cause symptoms that sometimes mimic dementia. Delirium. Delirium is characterized by confusion and rapidly altering mental states. >he person may also be disoriented, dro'sy, or incoherent, and may e=hibit personality changes. Delirium is usually caused by a treatable physical or psychiatric illness, such as poisoning or infections. atients 'ith delirium often, though not al'ays, make a full reco+ery after their underlying illness is treated.

A a /ang Men"ebabkan Demensia
Semua bentuk dari demensia dihasilkan dari kematian sel saraf dan atau kehilangan komunikasi antar sel saraf. Otak manusia sangat kompleks, banyak faktor yang mempengaruhi fungsinya. ara ahli belum mampu mengungkapkan faktor faktor yang mempengaruhi tersebut, tapi mereka telah mampu menyusun gambaran lengkap bagaimana demensia dapat berkembang. &enetik sangat berperan dalam perkembangan beberapa bentuk demensia. &enes clearly play a role in the de+elopment of some kinds of dementia. ada penyakit #lzeimer dan

banyak gangguan lainnya, tidak dapat dikaitkan dengan abnormailtas genetik saja. Bentuk demensia ini dihasilkan dari interaksi kompleks genetik, faktor gaya hidup, dan pengaruh lingkungan. ara peneliti telah mengidentifikasi beberapa gen yang mempengaruhi penyakit #lzeimer. 6utasi dari tiga gen yang diketahui sebagai gen penurun penyakit alzeimer yang mengontrol produksi protein seperti rotein rekursor #miloid "# $, resenilin ), dan resenilin 2 yang dihubungan dengan proses kejadian yang cepat dari penyakit #lzeimer. Bariasi dari gen lain, yang disebut #polipoprotein 4 "#po 4$ dihubungkan dengan peningkatan resiko kejadian lambat penyakit alzeimer. &en #po 4 tidak bekerja sendiri dalam menyebabkan penyakit, tapi salah satu bentuk dari gen ini yang disebut #po 4 4psilon 0 "#po4 40$ terlibat dalam meningkatkan resiko penyakit alzeimer. Seseorang dengan dua kopi &en #po4 40 memiliki resiko )1 kali berkembangnya penyakit alzeimer dibandingkan dengan seseorang tanpa #po4 40. bentuk +ariasi dari gen ini bah'a gen ini berhubungan dengan pertahanan yang lebih singkat pada pada pria terhadap penyakit alzeimer.

)*at Are t*e ,isk #actors !or Dementia+
9esearchers ha+e identified se+eral risk factors that affect the likelihood of de+eloping one or more kinds of dementia. Some of these factors are modifiable, 'hile others are not. Age. >he risk of #lzheimerJs disease, +ascular dementia, and se+eral other dementias goes up significantly 'ith ad+ancing age. %enetics/!amil" *istor". #s described in the section KLhat Dauses DementiaMK researchers ha+e disco+ered a number of genes that increase the risk of de+eloping #lzheimerJs disease. #lthough people 'ith a family history of #lzheimerJs disease are generally considered to be at heightened risk of de+eloping the disease themsel+es, many people 'ith a family history ne+er de+elop the disease, and many 'ithout a family history of the disease do get it. :n most cases, it is still impossible to predict a specific personJs risk of the disorder based on family history alone. Some families 'ith D@D, &SS, or fatal familial insomnia ha+e mutations in the prion protein gene, although these disorders can also occur in people 'ithout the gene mutation. :ndi+iduals 'ith these mutations are at significantly higher risk of de+eloping these forms of dementia. #bnormal genes are also clearly implicated as risk factors in <untingtonJs disease, N>D . )/, and se+eral other kinds of dementia. >hese dementias are described in the section KLhat are the different kinds of dementiaMK Smoking and alco*ol use. Se+eral recent studies ha+e found that smoking significantly increases the risk of mental decline and dementia. eople 'ho smoke ha+e a higher risk of atherosclerosis and other types of +ascular disease, 'hich may be the underlying causes for the increased dementia risk. Studies also ha+e found that drinking large amounts of alcohol appears to increase the risk of dementia. <o'e+er, other studies ha+e suggested that people 'ho drink moderately ha+e a lo'er risk of dementia than either those 'ho drink hea+ily or those 'ho completely abstain from drinking.

At*erosclerosis. #therosclerosis is the buildup of plaIue . deposits of fatty substances, cholesterol, and other matter . in the inner lining of an artery. #therosclerosis is a significant risk factor for +ascular dementia, because it interferes 'ith the deli+ery of blood to the brain and can lead to stroke. Studies ha+e also found a possible link bet'een atherosclerosis and #lzheimerJs disease. C*olesterol. <igh le+els of lo'.density lipoprotein "ADA$, the so.called bad form of cholesterol, appear to significantly increase a personJs risk of de+eloping +ascular dementia. Some research has also linked high cholesterol to an increased risk of #lzheimerJs disease. Plasma *omoc"steine. 9esearch has sho'n that a higher.than.a+erage blood le+el of homocysteine . a type of amino acid . is a strong risk factor for the de+elopment of #lzheimerJs disease and +ascular dementia. Diabetes. Diabetes is a risk factor for both #lzheimerJs disease and +ascular dementia. :t is also a kno'n risk factor for atherosclerosis and stroke, both of 'hich contribute to +ascular dementia. Mild cognitive im airment. Lhile not all people 'ith mild cogniti+e impairment de+elop dementia, people 'ith this condition do ha+e a significantly increased risk of dementia compared to the rest of the population. One study found that appro=imately 01 percent of people o+er age -* 'ho 'ere diagnosed 'ith mild cogniti+e impairment de+eloped dementia 'ithin ? years. Do0n s"ndrome. Studies ha+e found that most people 'ith Do'n syndrome de+elop characteristic #lzheimerJs disease plaIues and neurofibrillary tangles by the time they reach middle age. 6any, but not all, of these indi+iduals also de+elop symptoms of

1o0 Is Dementia Diagnosed+
Doctors employ a number of strategies to diagnose dementia. :t is important that they rule out any treatable conditions, such as depression, normal pressure hydrocephalus, or +itamin B)2 deficiency, 'hich can cause similar symptoms. 4arly, accurate diagnosis of dementia is important for patients and their families because it allo's early treatment of symptoms. Nor people 'ith #lzheimerJs disease or other progressi+e dementias, early diagnosis may allo' them to plan for the future 'hile they can still help to make decisions. >hese people also may benefit from drug treatment. >he Kgold standardK for diagnosing dementia, autopsy, does not help the patient or caregi+ers. >herefore, doctors ha+e de+ised a number of techniIues to help identify dementia 'ith reasonable accuracy 'hile the patient is still ali+e. Patient *istor" Doctors often begin their e=amination of a patient suspected of ha+ing dementia by asking Iuestions about the patientJs history. Nor e=ample, they may ask ho' and 'hen symptoms de+eloped and about the patientJs o+erall medical condition. >hey also may try to e+aluate the patientJs emotional state, although patients 'ith dementia often may be una'are of or in denial about ho' their disease is affecting them. Namily members also may deny the e=istence of the disease because they do not 'ant to accept the diagnosis and because, at least in the beginning, #lzheimerJs disease and other forms of dementia

can resemble normal aging. >herefore additional steps are necessary to confirm or rule out a diagnosis of dementia. P*"sical e2amination # physical e=amination can help rule out treatable causes of dementia and identify signs of stroke or other disorders that can contribute to dementia. :t can also identify signs of other illnesses, such as heart disease or kidney failure, that can o+erlap 'ith dementia. :f a patient is taking medications that may be causing or contributing to his or her symptoms, the doctor may suggest stopping or replacing some medications to see if the symptoms go a'ay. Neurological evaluations Doctors 'ill perform a neurological e=amination, looking at balance, sensory function, refle=es, and other functions, to identify signs of conditions . for e=ample mo+ement disorders or stroke . that may affect the patientJs diagnosis or are treatable 'ith drugs. Cognitive and neuro s"c*ological tests Doctors use tests that measure memory, language skills, math skills, and other abilities related to mental functioning to help them diagnose a patientJs condition accurately. Nor e=ample, people 'ith #lzheimerJs disease often sho' changes in so.called e=ecuti+e functions "such as problem.sol+ing$, memory, and the ability to perform once.automatic tasks. Doctors often use a test called the 6ini.6ental State 4=amination "66S4$ to assess cogniti+e skills in people 'ith suspected dementia. >his test e=amines orientation, memory, and attention, as 'ell as the ability to name objects, follo' +erbal and 'ritten commands, 'rite a sentence spontaneously, and copy a comple= shape. Doctors also use a +ariety of other tests and rating scales to identify specific types of cogniti+e problems and abilities. Brain scans Doctors may use brain scans to identify strokes, tumors, or other problems that can cause dementia. #lso, cortical atrophy .degeneration of the brainJs corte= "outer layer$ . is common in many forms of dementia and may be +isible on a brain scan. >he brainJs corte= normally appears +ery 'rinkled, 'ith ridges of tissue "called gyri$ separated by K+alleysK called sulci. :n indi+iduals 'ith cortical atrophy, the progressi+e loss of neurons causes the ridges to become thinner and the sulci to gro' 'ider. #s brain cells die, the +entricles "or fluid.filled ca+ities in the middle of the brain$ e=pand to fill the a+ailable space, becoming much larger than normal. Brain scans also can identify changes in the brainJs structure and function that suggest #lzheimerJs disease. >he most common types of brain scans are computed tomographic "D>$ scans and magnetic resonance imaging "69:$. Doctors freIuently reIuest a D> scan of the brain 'hen they are e=amining a patient 'ith suspected dementia. >hese scans, 'hich use O. rays to detect brain structures, can sho' e+idence of brain atrophy, strokes and transient ischemic attacks ">:#s$, changes to the blood +essels, and other problems such as hydrocephalus and subdural hematomas. 69: scans use magnetic fields and focused radio 'a+es to detect hydrogen atoms in tissues 'ithin the body. >hey can detect the

same problems as D> scans but they are better for identifying certain conditions, such as brain atrophy and damage from small >:#s. Doctors also may use electroencephalograms "44&s$ in people 'ith suspected dementia. :n an 44&, electrodes are placed on the scalp o+er se+eral parts of the brain in order to detect and record patterns of electrical acti+ity and check for abnormalities. >his electrical acti+ity can indicate cogniti+e dysfunction in part or all of the brain. 6any patients 'ith moderately se+ere to se+ere #lzheimerJs disease ha+e abnormal 44&s. #n 44& may also be used to detect seizures, 'hich occur in about )1 percent of #lzheimerJs disease patients as 'ell as in many other disorders. 44&s also can help diagnose D@D. Se+eral other types of brain scans allo' researchers to 'atch the brain as it functions. >hese scans, called functional brain imaging, are not often used as diagnostic tools, but they are important in research and they may ultimately help identify people 'ith dementia earlier than is currently possible. Nunctional brain scans include functional 69: "f69:$, single photon.emission computed tomography "S 4D>$, positron emission tomography " 4>$, and magnetoencephalography "64&$. f69: uses radio 'a+es and a strong magnetic field to measure the metabolic changes that take place in acti+e parts of the brain. S 4D> sho's the distribution of blood in the brain, 'hich generally increases 'ith brain acti+ity. 4> scans can detect changes in glucose metabolism, o=ygen metabolism, and blood flo', all of 'hich can re+eal abnormalities of brain function. 64& sho's the electromagnetic fields produced by the brainJs neuronal acti+ity. 3aborator" tests Doctors may use a +ariety of laboratory tests to help diagnose dementia andGor rule out other conditions, such as kidney failure, that can contribute to symptoms. # partial list of these tests includes a complete blood count, blood glucose test, urinalysis, drug and alcohol tests "to=icology screen$, cerebrospinal fluid analysis "to rule out specific infections that can affect the brain$, and analysis of thyroid and thyroid.stimulating hormone le+els. # doctor 'ill order only the tests that he or she feels are necessary andGor likely to impro+e the accuracy of a diagnosis. Ps"c*iatric evaluation # psychiatric e+aluation may be obtained to determine if depression or another psychiatric disorder may be causing or contributing to a personJs symptoms. Pres"m tomatic testing >esting people before symptoms begin to determine if they 'ill de+elop dementia is not possible in most cases. <o'e+er, in disorders such as <untingtonJs 'here a kno'n gene defect is clearly linked to the risk of the disease, a genetic test can help identify people 'ho are likely to de+elop the disease. Since this type of genetic information can be de+astating, people should carefully consider 'hether they 'ant to undergo such testing. 9esearchers are e=amining 'hether a series of simple cogniti+e tests, such as matching 'ords 'ith pictures, can predict 'ho 'ill de+elop dementia. One study suggested that a combination of a +erbal learning test and an odor.identification test can help identify #lzheimerJs disease before symptoms become ob+ious. Other studies are looking at 'hether memory tests and brain scans can be useful indicators of future dementia.

Is '*ere An" 'reatment !or Dementia+
Lhile treatments to re+erse or halt disease progression are not a+ailable for most of the dementias, patients can benefit to some e=tent from treatment 'ith a+ailable medications and other measures, such as cogniti+e training. Drugs to specifically treat #lzheimerJs disease and some other progressi+e dementias are no' a+ailable and are prescribed for many patients. #lthough these drugs do not halt the disease or re+erse e=isting brain damage, they can impro+e symptoms and slo' the progression of the disease. >his may impro+e the patientJs Iuality of life, ease the burden on caregi+ers, andGor delay admission to a nursing home. 6any researchers are also e=amining 'hether these drugs may be useful for treating other types of dementia. 6any people 'ith dementia, particularly those in the early stages, may benefit from practicing tasks designed to impro+e performance in specific aspects of cogniti+e functioning. Nor e=ample, people can sometimes be taught to use memory aids, such as mnemonics, computerized recall de+ices, or note taking. Beha+ior modification . re'arding appropriate or positi+e beha+ior and ignoring inappropriate beha+ior . also may help control unacceptable or dangerous beha+iors. Al4*eimer5s disease 6ost of the drugs currently appro+ed by the 7. S. Nood and Drug #dministration "ND#$ for #lzheimerJs disease fall into a category called cholinesterase inhibitors. >hese drugs slo' the breakdo'n of the neurotransmitter acetylcholine, 'hich is reduced in the brains of people 'ith #lzheimerJs disease. #cetylcholine is important for the formation of memories and it is used in the hippocampus and the cerebral corte=, t'o brain regions that are affected by #lzheimerJs disease. >here are currently four cholinesterase inhibitors appro+ed for use in the 7nited States! tacrine "Dogne=$, donepezil "#ricept$, ri+astigmine "4=elon$, and galantamine "9eminyl$. >hese drugs temporarily impro+e or stabilize memory and thinking skills in some indi+iduals. 6any studies ha+e sho'n that cholinesterase inhibitors help to slo' the decline in mental functions associated 'ith #lzheimerJs disease, and that they can help reduce beha+ioral problems and impro+e the ability to perform e+eryday tasks. <o'e+er, none of these drugs can stop or re+erse the course of #lzheimerJs disease. # fifth drug, memantine ";amenda$, is also appro+ed for use in the 7nited States. 7nlike other drugs for #lzheimerJs disease, 'hich affect acetylcholine le+els, memantine 'orks by regulating the acti+ity of a neurotransmitter called glutamate that plays a role in learning and memory. &lutamate acti+ity is often disrupted in #lzheimerJs disease. Because this drug 'orks differently from cholinesterase inhibitors, combining memantine 'ith other #lzheimerJs disease drugs may be more effecti+e than any single therapy. One controlled clinical trial found that patients recei+ing donepezil plus memantine had better cognition and other functions than patients recei+ing donepezil alone. Doctors may also prescribe other drugs, such as anticon+ulsants, sedati+es, and antidepressants, to treat seizures, depression, agitation, sleep disorders, and other specific problems that can be associated 'ith dementia. :n 211*, research sho'ed that use of KatypicalK antipsychotic drugs such as olanzapine and risperdone to treat beha+ioral problems in elderly people 'ith dementia 'as associated 'ith an ele+ated risk of death in

these patients. 6ost of the deaths 'ere caused by heart problems or infections. >he ND# has issued a public health ad+isory to alert patients and their caregi+ers to this safety issue. 6ascular dementia >here is no standard drug treatment for +ascular dementia, although some of the symptoms, such as depression, can be treated. 6ost other treatments aim to reduce the risk factors for further brain damage. <o'e+er, some studies ha+e found that cholinesterase inhibitors, such as galantamine and other #lzheimerJs disease drugs, can impro+e cogniti+e function and beha+ioral symptoms in patients 'ith early +ascular dementia. >he progression of +ascular dementia can often be slo'ed significantly or halted if the underlying +ascular risk factors for the disease are treated. >o pre+ent strokes and >:#s, doctors may prescribe medicines to control high blood pressure, high cholesterol, heart disease, and diabetes. Doctors also sometimes prescribe aspirin, 'arfarin, or other drugs to pre+ent clots from forming in small blood +essels. Lhen patients ha+e blockages in blood +essels, doctors may recommend surgical procedures, such as carotid endarterectomy, stenting, or angioplasty, to restore the normal blood supply. 6edications to relie+e restlessness or depression or to help patients sleep better may also be prescribed. &t*er dementias Some studies ha+e suggested that cholinesterase inhibitors, such as donepezil "#ricept$, can reduce beha+ioral symptoms in some patients 'ith arkinsonJs dementia. #t present, no medications are appro+ed specifically to treat or pre+ent N>D and most other types of progressi+e dementia. <o'e+er, sedati+es, antidepressants, and other medications may be useful in treating specific symptoms and beha+ioral problems associated 'ith these diseases. Scientists continue to search for specific treatments to help people 'ith Ae'y body dementia. Durrent treatment is symptomatic, often in+ol+ing the use of medication to control the parkinsonian and psychiatric symptoms. #lthough antiparkinsonian medication may help reduce tremor and loss of muscle mo+ement, it may 'orsen symptoms such as hallucinations and delusions. #lso, drugs prescribed for psychiatric symptoms may make the mo+ement problems 'orse. Se+eral studies ha+e suggested that cholinesterase inhibitors may be able to impro+e cogniti+e function and beha+ioral symptoms in patients 'ith Ae'y body disease. >here is no kno'n treatment that can cure or control D@D. Durrent treatment is aimed at alle+iating symptoms and making the patient as comfortable as possible. Opiate drugs can help relie+e pain, and the drugs clonazepam and sodium +alproate may help relie+e myoclonus. During later stages of the disease, treatment focuses on supporti+e care, such as administering intra+enous fluids and changing the personJs position freIuently to pre+ent bedsores.

)*at (ind o! Care Does a Person 0it* Dementia Need+
eople 'ith moderate and ad+anced dementia typically need round.the.clock care and super+ision to pre+ent them from harming themsel+es or others. >hey also may need

assistance 'ith daily acti+ities such as eating, bathing, and dressing. 6eeting these needs takes patience, understanding, and careful thought by the personJs caregi+ers. # typical home en+ironment can present many dangers and obstacles to a person 'ith dementia, but simple changes can o+ercome many of these problems. Nor e=ample, sharp kni+es, dangerous chemicals, tools, and other hazards should be remo+ed or locked a'ay. Other safety measures include installing bed and bathroom safety rails, remo+ing locks from bedroom and bathroom doors, and lo'ering the hot 'ater temperature to )21PN "03. CPD$ or less to reduce the risk of accidental scalding. eople 'ith dementia also should 'ear some form of identification at all times in case they 'ander a'ay or become lost. Daregi+ers can help pre+ent unsuper+ised 'andering by adding locks or alarms to outside doors. eople 'ith dementia often de+elop beha+ior problems because of frustration 'ith specific situations. 7nderstanding and modifying or pre+enting the situations that trigger these beha+iors may help to make life more pleasant for the person 'ith dementia as 'ell as his or her caregi+ers. Nor instance, the person may be confused or frustrated by the le+el of acti+ity or noise in the surrounding en+ironment. 9educing unnecessary acti+ity and noise "such as limiting the number of +isitors and turning off the tele+ision 'hen itJs not in use$ may make it easier for the person to understand reIuests and perform simple tasks. Donfusion also may be reduced by simplifying home decorations, remo+ing clutter, keeping familiar objects nearby, and follo'ing a predictable routine throughout the day. Dalendars and clocks also may help patients orient themsel+es. eople 'ith dementia should be encouraged to continue their normal leisure acti+ities as long as they are safe and do not cause frustration. #cti+ities such as crafts, games, and music can pro+ide important mental stimulation and impro+e mood. Some studies ha+e suggested that participating in e=ercise and intellectually stimulating acti+ities may slo' the decline of cogniti+e function in some people. 6any studies ha+e found that dri+ing is unsafe for people 'ith dementia. >hey often get lost and they may ha+e problems remembering or follo'ing rules of the road. >hey also may ha+e difficulty processing information Iuickly and dealing 'ith une=pected circumstances. 4+en a second of confusion 'hile dri+ing can lead to an accident. Dri+ing 'ith impaired cogniti+e functions can also endanger others. Some e=perts ha+e suggested that regular screening for changes in cognition might help to reduce the number of dri+ing accidents among elderly people, and some states no' reIuire that doctors report people 'ith #lzheimerJs disease to their state motor +ehicle department. <o'e+er, in many cases, it is up to the personJs family and friends to ensure that the person does not dri+e. >he emotional and physical burden of caring for someone 'ith dementia can be o+er'helming. Support groups can often help caregi+ers deal 'ith these demands and they can also offer helpful information about the disease and its treatment. :t is important that caregi+ers occasionally ha+e time off from round.the.clock nursing demands. Some communities pro+ide respite facilities or adult day care centers that 'ill care for dementia patients for a period of time, gi+ing the primary caregi+ers a break. 4+entually, many patients 'ith dementia reIuire the ser+ices of a full.time nursing home.

)*at (ind o! Care Does a Person 0it* Dementia Need+
eople 'ith moderate and ad+anced dementia typically need round.the.clock care and super+ision to pre+ent them from harming themsel+es or others. >hey also may need assistance 'ith daily acti+ities such as eating, bathing, and dressing. 6eeting these needs takes patience, understanding, and careful thought by the personJs caregi+ers. # typical home en+ironment can present many dangers and obstacles to a person 'ith dementia, but simple changes can o+ercome many of these problems. Nor e=ample, sharp kni+es, dangerous chemicals, tools, and other hazards should be remo+ed or locked a'ay. Other safety measures include installing bed and bathroom safety rails, remo+ing locks from bedroom and bathroom doors, and lo'ering the hot 'ater temperature to )21PN "03. CPD$ or less to reduce the risk of accidental scalding. eople 'ith dementia also should 'ear some form of identification at all times in case they 'ander a'ay or become lost. Daregi+ers can help pre+ent unsuper+ised 'andering by adding locks or alarms to outside doors. eople 'ith dementia often de+elop beha+ior problems because of frustration 'ith specific situations. 7nderstanding and modifying or pre+enting the situations that trigger these beha+iors may help to make life more pleasant for the person 'ith dementia as 'ell as his or her caregi+ers. Nor instance, the person may be confused or frustrated by the le+el of acti+ity or noise in the surrounding en+ironment. 9educing unnecessary acti+ity and noise "such as limiting the number of +isitors and turning off the tele+ision 'hen itJs not in use$ may make it easier for the person to understand reIuests and perform simple tasks. Donfusion also may be reduced by simplifying home decorations, remo+ing clutter, keeping familiar objects nearby, and follo'ing a predictable routine throughout the day. Dalendars and clocks also may help patients orient themsel+es. eople 'ith dementia should be encouraged to continue their normal leisure acti+ities as long as they are safe and do not cause frustration. #cti+ities such as crafts, games, and music can pro+ide important mental stimulation and impro+e mood. Some studies ha+e suggested that participating in e=ercise and intellectually stimulating acti+ities may slo' the decline of cogniti+e function in some people. 6any studies ha+e found that dri+ing is unsafe for people 'ith dementia. >hey often get lost and they may ha+e problems remembering or follo'ing rules of the road. >hey also may ha+e difficulty processing information Iuickly and dealing 'ith une=pected circumstances. 4+en a second of confusion 'hile dri+ing can lead to an accident. Dri+ing 'ith impaired cogniti+e functions can also endanger others. Some e=perts ha+e suggested that regular screening for changes in cognition might help to reduce the number of dri+ing accidents among elderly people, and some states no' reIuire that doctors report people 'ith #lzheimerJs disease to their state motor +ehicle department. <o'e+er, in many cases, it is up to the personJs family and friends to ensure that the person does not dri+e. >he emotional and physical burden of caring for someone 'ith dementia can be o+er'helming. Support groups can often help caregi+ers deal 'ith these demands and they can also offer helpful information about the disease and its treatment. :t is important that caregi+ers occasionally ha+e time off from round.the.clock nursing demands. Some communities pro+ide respite facilities or adult day care centers that 'ill care for dementia

patients for a period of time, gi+ing the primary caregi+ers a break. 4+entually, many patients 'ith dementia reIuire the ser+ices of a full.time nursing home. 64D:D:;4;4>.DO6 #S7<#; K4 49#L#>#; #D# D464;S:# D:#&;OS:S K4 49#L#>#; H#;& 67;&K:; ). 9esiko Dedera b.d 6engeluyur

<asil yang diharapkan ! Klien tidak tersesat atau tidak mengalami cedera ketika menggeluyur :nter+ensi ! % <indari restrein fisik % Berikan area yang aman untuk menggeluyur % >andai kamar penghuni dengan jelas menggunakan foto atau nama dan masukkan benda milik penghuni yang ia kenal diruangan tersebut % Aetakkan alarm disemua pintu keluar dan pintu yang berbahaya % astikan bah'a penghuni memakai pakaian yang tepat untuk cuaca saat itu % Kaji adanya resiko jatuh 2. erubahan pola eliminasi urine akibat perubahan persepsi, kerusakan sistem saraf, atau infeksi saluran kemih yang sering terjadi

<asil yang Diharapkan ! Klien mempertahankan kontinensia pada empat dari lima kali berkemih :nter+ensi ! % >andai kamar mandi dengan QpriaR dan Q'anitaR dan gunakan pita atau panah untuk menunjukkan jalan ke kamar mandi % &unakan pola berkemih yang segera berdasarkan pola berkemih indi+idu "mis ! memba'a ke kamar mandi setiap 2 sampai ? jam, setelah makan, atau sebelum tidur$ % >a'arkan cairan setiap dua jam di siang hari ! batasi cairan setelah jam sore % &unakan celana tahan air hanya jika diperlukan untuk mencegah kecelakaan dan rasa malu % &unakan alat penyuluhan untuk meningkatkan pembelajaran ulang tentang rasa penuh pada kandung kemih jika orang tersebut mampu mengenali perasaan tersebut ?. &angguan Kognisi b.d proses penyakit

<asil yang diharapkan !

Klien berfungsi pada tingkat yang setinggi mungkin :nter+ensi ! % Bantu dengan alat bantu sensori "mis ! alat bantu dengar, kacamata$ % &unakan kalimat yang singkat dan sederhana, jangan memberikan pilihan % >ingkatkan rasa percaya dengan menggunakan sentuhan "jika tepat$ atau nada suara yang tidak mengancam % uji perilaku yang diinginkan dan abaikan perilaku yang tidak tepat % &unakan label nama bertulisan besar untuk pasien dan staf % Beri label pada ruangan, lemari, dan laci.laci dengan nama orang tersebut % &unakan pendekatan yang tenang, tidak tergesa gesa terhadap akti+itas asuhan % @elaskan kejadian kejadian dengan cara sesederhana mungkin tepat sebelum terjadi % erkenalkan diri anda setiap kali anda melakukan kontak dengan penghuni % #njurkan penggunaan benda benda yang dikenal dan mengingat kembali dengan menggunakan album foto 0. erubahan ;utrisi ! beresiko mengalami perubahan kebutuhan

<asil yang diharapkan ! Klien tidak mengalami defisiensi nutrisi :nter+ensi ! % % % % % *. Beri makanan seimbang ? kali sehari, tingkatkan karbohidrat kompleks Batasi garam dan gula ekstra jika mungkin >a'arkan cairan setiap 2 jam, hindari kafein >a'arkan buah buahan dan serat untuk melancarkan eliminasi >a'arkan makanan yang mudah dikunyah atau berikan makanan yang mudah diambil dengan tangan

erubahan ola >idur

<asil yang diharapkan ! :nter+ensi ! % Kurangi tidur di sore menjelang malam hari ! ganti tidur di pagi hari untuk mengkompensasi perubahan tahap tahap tidur % Aibatkan dalam akti+itas sehari hari seperti latihan "duduk$, berjalan dan bermain % Kudapan karbohidrat menjelang tidur dapat menghilangkan kebutuhan akan pil tidur % &unakan lampu malam untuk membantu orientasi % Kaji adanya reaksi kegelisahan dan insomnia yang dapat terjadi sebagai respons terhadap sedatif, hipnotik, atau psikotropik

>#<# #; D464;S:# >ahap #'al erubahan alam perasaan atau kepribadian &angguan penilaian dan penyelesaian masalah Konfusi tentang tempat "tersesat pada saat akan ke toko$ Konfusi tentang 'aktu Kesulitan dengan angka, uang, dan tagihan #nomia "kesulitan menyebut nama benda$ ringan 6enarik diri atau depresi >ahap pertengahan &angguan memori saat ini dan masa lalu #nomia, agnosia "ketidakmampuan mengenali objek yang umum$, apraksia "ketidakmampuan melakukan gerakan yang bertujuan$, afasia &angguan penilaian dan penyelesaian masalah yang parah Konfusi tentang 'aktu dan tempat semakin memburuk &angguan persepsi Kehilangan pengendalian impuls #nsietas, gelisah, menggeluyur, berkeras <iperoralitas Kemungkinan kecurigaan, delusi, atau halusinasi Konfabulasi &angguan kemampuan mera'at diri yang sangat besar 6ulai terjadi inkontinensia &angguan siklus tidur.bangun >ahap #khir &angguan yang parah pada semua kognitif Ketidakmampuan untuk mengenali keluarga dan teman teman &angguan komunikasi yang parah "dapat menggerutu, mengeluh, menggumam$ Sedikitnya kapasitas pera'atan diri :nkontinensia kandung kemih dan usus <iperoral dan memiliki tangan yang aktif enurunan nafsu makan, disfasia dan resiko aspirasi Depresi sistem imun yang menyebabkan meningkatnya resiko infeksi &angguan mobilitas dengan hilangnya kemampuan untuk berjalan, kaku otot 6enarik diri &angguan siklus tidur.bangun dengan peningkatan 'aktu tidur.

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