apa: linee guida per la pratica psicologica: il punto di ... · formale di gerontopsicologia per...
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Giancarlo Logroscino MD PhD
Neurodegenerative Diseases Unit
Department of Basic Medicine
Neuroscience and Sense Organs
Department of Clinical Research in
Neurology of the University of Bari at
“Pia Fondazione Card G. Panico“
Hospital Tricase (Le)
University Aldo Moro Bari Italy
APA: Linee Guida per
la Pratica Psicologica:
Il punto di vista del
neurologo
Processing
Speed
Sustained
Learning
Recall
Recognition
Naming
Comprehension
Production
Cognitive
Flexibility
Cognitive
Inhibition
Focused
Working
memory
Praxis Gnosis
Planning
ATTENTION
LANGUAGE
MEMORY
EXECUTIVE
FUNCTIONS
VISUOSPATIAL
ABILITIES
COGNITIVE FUNCTIONING
Neuropsychology in diagnosis: Timing
Nature Neur., (6), 2010
• memory tests change relatively early in the disease course (1) and soon reach a plateau at high levels of impairment (2)
• They are useful for diagnosis at the MCI stage, but are less useful for tracking later disease progression (3).
• Verbal comprehension tests start to change later in the disease course: during MCI they show mild or no impairment (4), and are of limited use in diagnosis.
• These markers become more sensitive at the dementia stage, when the slope of change steepens (5)
NEUROCOGNITIVE
DOMAINS
Social cognition Recognition of emotions,
teory of mind
Perception Visual perception, visuoconstructional,
perceptual-motor, praxis and gnosis
Learning and Memory Immediate and recent memory; long term memory
Executive function Planning, decision making, working memory, mental flexibility, cognitive inhibition
Complex attention Sustained, divided, selective and processing speed
MILD NEUROCOGNITIVE
DISORDER
NEUROPSICOLOGY
CLINICAL RESEARCH
Assessment
Multidisciplinary team:
Neurologist, Imaging,
Laboratory
Intervention
- Psychological interventions: patient/caregiver
- Cognitive rehabilitation
Diagnosis Cognitive profile
Medici di Medicina Generale
(Primary Care)
e demenze
•Diagnosi precoce
•Buon trattamento
NEUROPSICOLOGY
CLINICAL RESEARCH
Cognitive screening
to detect global
impairment
1. Comprehensive assessment to
identify cognitive phenotype
2. Behavioral evaluation: apathy,
depressive symptoms etc.
SETTING
Clinical center
MMG
Population based
ASSESSMENT
APA document: Training Inadeguato
• 58% non si sentivano preparati a lavoro
clinico con i 65+
• 70 ritenevano di dover riqualificarsi con un
formale di gerontopsicologia per lavorare
con i 65+
Somministro test cognitivi di screening quando sospetto
la presenza di un disturbo della memoria o di altro
disturbo cognitivo
APA document:
Challenges of Clinical Work among Older Adults
• cohort (generational)
• perspectives and beliefs (e.g., family obligations,
perceptions of mental disorders),
• comorbid physical illnesses,
• the potential for and effects of polypharmacy,
• cognitive or sensory impairments
• history of medical or mental/ neurological
disorders