how to diagnose mci
TRANSCRIPT
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Mild Cognitive ImpairmentMild Cognitive Impairment
How to diagnoseHow to diagnose
Paulus Anam OngMemory Clinic - Hasan Sadikin Hospital Bandung
Padjadjaran University - Indonesia
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Ou tline of PresentationOu tline of Presentation
IntroductionIntroduction Aging in Indonesia Aging in Indonesia Progression of normal aging to MCIProgression of normal aging to MCI
Early detection is the main roleEarly detection is the main roleClinical Diagnostic of MCIClinical Diagnostic of MCI Definition of MCIDefinition of MCI Clinical diagnostic of MCIClinical diagnostic of MCI
MMSEMMSE CDRCDR GDSGDSConclusionConclusion
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Aging in Indonesia Aging in Indonesia Aging in Indonesia Aging in Indonesia
0
10000
20000
30000
40000
50000
60000
1997 2025 2050
80+
75 - 79
65 - 74
N N (1000 s)(1000 s)
N N (1000 s)(1000 s)
(WHO, 1998)(WHO, 1998)
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T he 4th populous elderly after China, IndiaT he 4th populous elderly after China, Indiaand South Americaand South America
We will encounter large numbers of dementia cases in the futurein the future
Massive medical, social, and economicMassive medical, social, and economic
problems in the futureproblems in the future
..
IndonesiaIndonesia
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Progression of normal aging to dementiaProgression of normal aging to dementia
Brain AgingN ormalCognition
ProdromalDementia
Dementia
Mild Cognitive
Impairment
Other Dementias
AlzheimersDisease
Vascular Dementia
Stable or ReversibleImpairment
Reversible
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Progression of normal aging toProgression of normal aging todementiadementia
A minority of persons diagnosed with A minority of persons diagnosed withMCI remain stable or improve overMCI remain stable or improve overtimetimeT he majority of declining MCI patientsT he majority of declining MCI patientsconvert to AD, besides mixed withconvert to AD, besides mixed with
vascular and other dementiavascular and other dementia
Golumb J, Kluger A, Ferrsis SH. Mild Cognitive Impairment:
Identifying and treating the earliest stage of Alzheimer s disease
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Correct diagnosis in its early stages can be:Correct diagnosis in its early stages can be:
Beneficial of treatment Beneficial of treatment
Prevent costly and inappropriate treatment Prevent costly and inappropriate treatment resulting from misdiagnosisresulting from misdiagnosis
Give patients and families time to prepareGive patients and families time to preparefor the challenging financial, legal, andfor the challenging financial, legal, andmedical decisions that may lie ahead.medical decisions that may lie ahead.
Early detection of MCI cases is theEarly detection of MCI cases is themain rolemain role
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Definition of MCIDefinition of MCI
Memory Complaints confirmed by an informant Memory Complaints confirmed by an informant
Normal activities of daily livingNormal activities of daily living
General cognitive preservedGeneral cognitive preserved Abnormal memory for age and education Abnormal memory for age and educationnorms (1,5 SD below normative values )norms (1,5 SD below normative values )
Not dementedNot demented
Petersen et al (1999) Arch Neurol 56,303-308
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MCI Tenets :MCI Tenets :
Not all MCI represent ADNot all MCI represent AD
All AD patients go through an MCI stage All AD patients go through an MCI stage
AD symptoms progress from MCI to greater severity of AD symptoms progress from MCI to greater severity of
dementiadementia
Conversions Conversions ( MCI to AD ) is a clinical construct ( MCI to AD ) is a clinical construct
inconsistent with pathologyinconsistent with pathology
Clinical methods accurately identify MCIClinical methods accurately identify MCI AD AD
Quality of clinical information ( informants ) andQuality of clinical information ( informants ) and
labeling threshold of clinician determines diagnosislabeling threshold of clinician determines diagnosis
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Clinical Diagnosis of MCIClinical Diagnosis of MCI
Diagnosis of MCI requires anDiagnosis of MCI requires aninformant based history documentinginformant based history documentinga meaningful deterioration in cognitivea meaningful deterioration in cognitivestatus in daily functioningstatus in daily functioningT wo commonly used rating scalesT wo commonly used rating scales
Clinical Dementia Rating (CDR)Clinical Dementia Rating (CDR) Global Deterioration Scale (GDS)Global Deterioration Scale (GDS)
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MCI Clinical AssessmentMCI Clinical Assessment
As a part of dementia assessment: As a part of dementia assessment:Careful history from familyCareful history from familymember / collateral source (keymember / collateral source (keyelement) and from patient element) and from patient Physical / neurological examinationPhysical / neurological examinationEvaluation of behavior and moodEvaluation of behavior and mood
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Clinical approach :Clinical approach :
General medical historyGeneral medical history
CCVD and risk factorCCVD and risk factor
Endocrine disordersEndocrine disorders
Chronic infectionsChronic infectionsLife styleLife style
General neurologic historyGeneral neurologic history
Specific conditionsSpecific conditionsWhich could be responsible for dementiaWhich could be responsible for dementia
Head traumaHead trauma
SOL intracranialSOL intracranial
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Clinical approach :Clinical approach :
Psychiatric history :Psychiatric history :Pure psychiatric disordersPure psychiatric disorders
Cognitive impairment Cognitive impairment
associated with psychiatric diseasesassociated with psychiatric diseasesT oxic, nutritions and drug historyT oxic, nutritions and drug historyFamily historyFamily history
DementiaDementiaDown s syndromeDown s syndrome
Degenerative diseasesDegenerative diseases
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Clinical approach :Clinical approach :
General physical examination :General physical examination :
Vital signs Vital signs
Risk factor for vascular eventsRisk factor for vascular events
Metabolic and endocrineMetabolic and endocrine
Neurological examinationNeurological examination
Focal deficit Focal deficit Abnormalities of muscle tone, movement or Abnormalities of muscle tone, movement orprimitive reflexesprimitive reflexes
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Ne u ropsychological examinationsNe u ropsychological examinations
Minimental State Examination ( MMSE ) :Minimental State Examination ( MMSE ) : uu 2424Clinical Dementia Rating Scale ( CDR )Clinical Dementia Rating Scale ( CDR ) 0,50,5
MemoryMemoryOrientationsOrientationsJudgment and problem solvingJudgment and problem solvingCommunity affairsCommunity affairsHome and hobbiesHome and hobbies
Personal carePersonal careGlobal Deterioration Scale ( GDS ):stage 2Global Deterioration Scale ( GDS ):stage 2- -33
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Mini Mental Stat u sMini Mental Stat u s
Examination (MMS E)Examination (MMS E)
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Mini Mental Stat u sMini Mental Stat u s
Examination (MMS E) Examination (MMS E) Screening test to provide brief,Screening test to provide brief,objective measure of cognitiveobjective measure of cognitivefunction.function.
Administered in 10 Administered in 10- -15 minutes, scores15 minutes, scoresrange from 0 to 30range from 0 to 30
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MMS E: Different cognitiveMMS E: Different cognitivedomains testeddomains tested
Questions grouped into seven categories:Questions grouped into seven categories:Orientation to timeOrientation to time 5 points5 pointsOrientation to placeOrientation to place 5 points5 pointsRegistration of three wordsRegistration of three words 3 points3 points
Attention and calculation Attention and calculation 5 points5 pointsRecall of three wordsRecall of three words 3 points3 pointsLanguageLanguage 8 points8 points
Visual construction Visual construction 1 point 1 point
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N oN o TesTes N ilaiN ilaimakmak
N ilaiN ilai
ORIE N TASIORIE N TASI11 Sekarang (tahun), (musim), (bulan), (tanggal), hariSekarang (tahun), (musim), (bulan), (tanggal), hari
apa?apa?
55 ------
22 Kita berada dimana? (negara), (propinsi), (kota),Kita berada dimana? (negara), (propinsi), (kota),(rumah sakit), (lantai/kamar)(rumah sakit), (lantai/kamar)
55 ------
REGISTRASIREGISTRASI33 Sebutkan 3 buah nama benda ( Apel, Meja, Koin),Sebutkan 3 buah nama benda ( Apel, Meja, Koin),
tiap benda 1 detik, pasien disuruh mengulangitiap benda 1 detik, pasien disuruh mengulangiketiga nama benda tadi.ketiga nama benda tadi.
33 ------
ATE N SI DA N KALKULASIATE N SI DA N KALKULASI44 Kurangi 100 dengan 7. Nilai 1 untuk tiap jawabanKurangi 100 dengan 7. Nilai 1 untuk tiap jawaban
yang benar. Hentikan setelah 5 jawaban. Atauyang benar. Hentikan setelah 5 jawaban. Ataudisuruh mengeja terbalik kata WAHYUdisuruh mengeja terbalik kata WAHYU
55 ------
PEMERIKSAA N STATUS ME N TAL MI N I (MMSE)P OK DI FU NG SI LUHUR PUS AT (modifikasi F O LSTEI N)
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ME N GIN GAT KEMBALI ( RECALL )5 Pasien disuruh menyebut kembali 3 nama benda di
atas3 ---
BAHASA6 Pasien disuruh menyebutkan nama benda yang
ditunjukkan ( pensil, buku)2 ---
7 Pasien disuruh mengulang kata-kata: namun , tanpa, bila 1 ---
8 Pasien disuruh melakukan perintah: Ambil kertas inidengan tangan anda, lipatlah menjadi dua danletakkan di lantai.
3 ---
9 Pasien disuruh membaca dan melakukan perintah
Pejamkanlah mata anda
1 ---
10 Pasien disuruh menulis dengan spontan 1 ---11 Pasien disuruh menggambar bentuk di bawah ini 1 ---
Total 3 0 ---
PEMERIKSAA N STATUS ME N TAL MI N I (MMSE)
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Penilaian MMS E
Nilai:
24 -30: T idak ada gangguan kognitif 17 -23: Probable gangguan kognisi0 - 16: Definite gangguan kognisi
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Good points of the MMS EGood points of the MMS E
Most widely accepted screening test Most widely accepted screening test Good internal consistencyGood internal consistency
Good test Good test- -retest reliabilityretest reliabilityHigh validity: good sensitivity and specificityHigh validity: good sensitivity and specificityCorrelates well with other screening tests e.g.Correlates well with other screening tests e.g.
clock drawing test and Short Blessed test clock drawing test and Short Blessed test Can be used for diagnostic, follow up,Can be used for diagnostic, follow up,measurement of therapeutic outcomemeasurement of therapeutic outcome
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Correlation between ADL and MMSE
An integrated approach to the management of AD. Eur J Neurol.5 (suppl 4). S9-17
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LimitationLimitation
Confounded by age, education and culture.Confounded by age, education and culture.
Highly educated people with obvious dementiaHighly educated people with obvious dementia
may score 27 or above (ceiling effect)may score 27 or above (ceiling effect)
Non demented subjects with modest educationalNon demented subjects with modest educationalattainment may score as low as 24 (floor effect)attainment may score as low as 24 (floor effect)
Can not be used as a single tool for diagnosisCan not be used as a single tool for diagnosisand it has to be interpreted within context of and it has to be interpreted within context of clinical history and examinationclinical history and examination
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Concl u sions from the MMS EConcl u sions from the MMS E
U seful in quantitatively estimating the U seful in quantitatively estimating the
severity of cognitive impairmentseverity of cognitive impairment
...in serially documenting cognitive ...in serially documenting cognitivechangechange
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Clinical Dementia RatingClinical Dementia Rating(CDR)(CDR)
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SemiSemi--structured interview with thestructured interview with thepatient/subject and a wellpatient/subject and a well- -informedinformedcollateral source (informant).collateral source (informant).
For diagnosis, staging, and changes (forFor diagnosis, staging, and changes (forclinical trial)clinical trial)More than 90% sensitivity and specificity.More than 90% sensitivity and specificity.
Validated against neuropathology Validated against neuropathologyinformation (Morris et al, 1988)information (Morris et al, 1988)One of the Gold Standard of Global rating of One of the Gold Standard of Global rating of dementia in trial of patients with ADdementia in trial of patients with AD
Clinical Dementia Rating (C DR)Clinical Dementia Rating (C DR)
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FaceFace validityvalidity:: measuresmeasures declinedecline relativerelative toto thetheindividualindividual that that interferesinterferes withwith usualusual functionsfunctionsMultidimensionalMultidimensionalClinically meaningful, even whenClinically meaningful, even whenneuropsychological test is normalneuropsychological test is normal
Avoids Avoids confoundsconfounds factorsfactors ee..gg.. education,education, ageage;;practicepractice effectseffects that that affect affect cognitivecognitive teststests
LessLess affectedaffected byby ceiling ceiling andand floor floor effectseffectsReliableReliable
Morris JC, Clinical Dementia Rating, 3 rd Asia-Pacific Regional Meeting of
!WGH, Bangkok 24 th -26 th March 2004
Advantages of Advantages of CDRCDR
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RelyRely onon availabilityavailability of of aa goodgood collateralcollateral
sourcesource (eg(eg.. caregiver)caregiver)Interviews are timeInterviews are time- -consumingconsumingcompared to brief cognitive testscompared to brief cognitive tests
RequireRequire clinicalclinical judgment judgment
Morris JC, Clinical Dementia Rating, 3 rd Asia-Pacific Regional Meeting of !WGH, Bangkok 24 th -26 th March 2004
Disadvantages of C DRDisadvantages of C DR
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Clinical Dementia RatingClinical Dementia Rating
(C DR)(C DR)Provides assessment of 6 domains / categories:Provides assessment of 6 domains / categories:3 cognitive + 3 functional domains.3 cognitive + 3 functional domains.
Cognitive domains:Cognitive domains:1. Memory1. Memory2. Orientation2. Orientation3. Judgment and problem solving ability3. Judgment and problem solving abilityFunctional domains:Functional domains:4. Community affairs4. Community affairs5. Home and hobbies5. Home and hobbies6. Personal care.6. Personal care.
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Clinical Dementia RatingClinical Dementia Rating
Impairment Impairment
00NoneNone
0.50.5QuestionableQuestionable
11MildMild
22ModerateModerate
33SevereSevere
MemoryMemory
OrientationOrientation
Judgment and problem solvingJudgment and problem solving
Community AffairsCommunity Affairs
Home & HobbiesHome & Hobbies
Personal CarePersonal Care
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Clinical Dementia RatingClinical Dementia Rating
None0
Questionable0.5
Mild 1 Moderate 2 Severe 3
Memory Nomemoryloss, or
slight inconsistent forgetful-ness
Consistent slight forgetfulnes;
partialrecollectionof events; benignforgetfulness
Moderate memorylose; more markedfor recent events;
defect interferes witheveryday activities
Severememoryloss; only
highlylearnedmaterialretained,newmaterialrapidly lost
Severememoryloss; only
fragmentsremain
Orientation Fullyoriented
Fullyorientedexcept forslight difficultywith timerelationship
Some difficulty withtime relationship;oriented for place&person at examination, but mayhave geographicdisorientation
Usuallydisorientedto time,often toplace
Orientedto persononly
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Clinical Dementia RatingClinical Dementia Rating
None0
Questionable0.5
Mild 1 Moderate 2 Severe 3
Judgement andproblemsolving
Solveseverydayproblems andhandles
business andfinancial affairswell;
judgement good in relationto past performance
Slight impairment in solvingproblems,
similaritiesanddifferences
Moderatedifficulty inhandlingproblem,
similarities anddifferences;social judgement usuallymaintained
Severely impairedin handlingproblems,similarities and
differences; social judgement usuallyimpaired
Unable tomake
judgements orsolve
problems
Communityaffair
Independent function at usual level in
job, shopping,and volunteerand socialgroups
Slight impairment in theseactivities
Unable tofunctionindependently at these activitiesalthough may stillbe engaged insome; appearsnormal to causal
inspection
No pretense of independent function outsidehome. Appearswell enough to betaken to functionsoutside a familyhome
No pretense of independent functionoutside home.
Appears too illto be taken tofunctionsoutside a
family home
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Clinical Dementia RatingClinical Dementia Rating
None0
Questionable0.5
Mild 1 Moderate 2 Severe 3
Homeandhobbies
Life at home,hobbies andintellectualinterest well
maintained
Life at home,hobbies andintellectualinterests
slightlyimpaired
Mild but definiteimpairment of function at home; more
difficult choresabandoned;morecomplicatedhobbies andinterest abandoned
Only single chorespreserved; veryrestricted interest,poorly maintained
No significant function inhome
Personalcare
Fully capable of self-care Needs prompting Requiresassistance indressing, hygiene,keeping of personal effects
Requiresmuch helpwith personalcare; frequent incontinence
Morris JC,. Neurologly 1993; 43:2412-14(20)
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CDRCDR DiagnosisDiagnosis
T hree classificationT hree classification No dementiaNo dementia = CDR 0= CDR 0 Uncertain dementia = CDR 0.5Uncertain dementia = CDR 0.5
(questionable dementia / MCI)(questionable dementia / MCI) DementiaDementia
CDR 0.5 = very mild dementiaCDR 0.5 = very mild dementiaCDR 1 = mild dementiaCDR 1 = mild dementiaCDR 2 = moderate dementiaCDR 2 = moderate dementiaCDR 3 = severe dementiaCDR 3 = severe dementia
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Definition of C DR 0.5Definition of C DR 0.5
..for subjects who are neither clearlydemented nor healthy. Many in this group havesyndromes compatible with the benign senescent forgetfulness of Kral while others probably havenormal cognitive function but may be mildlydepressed or concerned over minor forgetfulness.Still others are probably in an early stage of SDA T
Hughes et al. Brit J Psychiat 1982;140;566-572
Morris JC, Clinical Dementia Rating, 3 rd Asia-Pacific Regional Meeting of
!WGH, Bangkok24 th
-26 th
March2004
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Global Deterioration ScaleGlobal Deterioration ScaleGDSGDS
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Global Deterioration ScaleGlobal Deterioration Scale
A seven A seven--point rating scalepoint rating scaleStage 1: normal cognitive capacityStage 1: normal cognitive capacityStage 2: normal agingStage 2: normal agingStage 3: mild memory impairment Stage 3: mild memory impairment (MCI)(MCI)Stage 4: Mild ADStage 4: Mild ADStage 5: Moderate ADStage 5: Moderate AD
Stage 6:Moderately severe ADStage 6:Moderately severe ADStage 7: Severe ADStage 7: Severe AD
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Global deterioration scaleGlobal deterioration scaleClinical CharacteristicsClinical Characteristics
GDSStage
Clinical Characteristics
1Normal
No Subjective c omplaints of memory def icitNo memory deficit evident on clinical interview
2Normalaging
Subjective c omplaints of memory def icit,Most frequently in the following areas:
forgetting where one has placed familiar objectsforgetting names one formerly knew well
No objective evidence of memory deficits on clinical interviewNo objective deficit in employment or social situations Appropriate concern with respect to symptomatology
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Global deterioration scaleGlobal deterioration scaleClinical CharacteristicsClinical Characteristics
GDSStage
Clinical Characteristics
4
Mild AD
Clear-cut de f icit on care f ul clinical interviewDeficit manifest in following areas:
Decrease knowledge of current and recent events
May exhibit some deficit in memory of ones personal historyConcentration deficit elicited on serial subtractionsDecreased ability to travel, handle finances, etcFrequently no deficit in the following areas:Orientation of familiar persons and faces
Ability to travel to familiar locationsnability to per for m complex task
Denial is dominant defence mechanismFlattering of affect and withdrawal from challenging situation occur
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Global deterioration scaleGlobal deterioration scaleClinical CharacteristicsClinical Characteristics
GDSStage Clinical Characteristics
5
Moderate AD
P atient can n o longer survive with out some assistancePatient is unable during interview to recall a major relevant aspect of their
current life. For example:Their address or telephone number for many yearsThe names of closes members of their family (e.g grandchildren)The name of the high school or college from which they graduated
Frequently some disorientation to time (date, day of the week, season, etc) or to place
An educated person may have difficulty counting back from 40 by for fours or from 20 by twos
Person at this stage retain knowledge of many major facts regardingthemselves and others
They invariably know their own names and generally know their spouses andchildrens names
They require no assistance with toileting or eating, but may have difficultychoosing the proper clothing to wear
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Global deterioration scaleGlobal deterioration scaleClinical CharacteristicsClinical Characteristics
GDS Stage Clinical Characteristics
6
Moderatelysevere
AD
May occasionally forget the name of the spouse upon whom they areentirely dependent for survival
Will belargely unaware of all recent events and ex periences in their lives
Retain some knowledge of their surroundings; the yea, the season etcMay have difficulty counting by ones from 10, both backward and sometimesforward
Will require some assistance with activities of daily livingMay become incontinentWill require travel assistance but occasionally will be able to travel to
familiar locationDiurnal rhythm frequently disturbed Almost always recall their own nameFrequently continue to be able to distinguish familiar from unfamiliar persons
in their environment
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Global deterioration scaleGlobal deterioration scaleClinical CharacteristicsClinical Characteristics
GDS Stage Clinical Characteristics
6
Moderately
severe AD
Personality and emotional changes occur, these are quite variable andinclude:Delusional behaviour (eq, patients may accuse their spouse of beingan imposter; may talk to imaginary fiqures in the environment, or totheir own reflection in the mirror)Obsessive symptoims (eg. Person may continually repeat simplecleaning activities) Anxiety symptoms, agitation, and even previously non-existent violentbehaviour may occur Cognitive abulia (eg. Loss of willpower because an individual can notcarry a thought long enough to determine a purposeful course of action)
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Global deterioration scaleGlobal deterioration scaleClinical CharacteristicsClinical Characteristics
GDS Stage Clinical Characteristics
7
Moderately
severe AD
(sambungan)
All verbal abilities are lost over the course of this stageEarly in this stage words and phrases are spoken but speech is very
circumscribed
Later there is no speech at all- only babblingIncontinent of urine, requires assistance toileting and feedingBasic psychomotor skill (eq, abililty to walk), are lost with the progression o
this stageThe brain appears to no longer be able to tell the body what to do
Generalized and cortical neurological signs and symptoms are frequentlypresent
Reisberg B, Ferris FH, de Lean MJ et al. The global deterioration scale forassessment of primary degenerative dementia
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T he best diagnostic test is a careful T he best diagnostic test is a carefulhistory and physical and mental statushistory and physical and mental statusexamination by a physician with aexamination by a physician with aknowledge of and interest in dementiaknowledge of and interest in dementiaand the dementing disease. Such anand the dementing disease. Such anevaluation is time consuming, but evaluation is time consuming, but nothing can replace itnothing can replace it
Differential diagnosis of dementing diseases.NIH Consensus Statement.Differential diagnosis of dementing diseases.NIH Consensus Statement.J AM A 1987, 258:3411J AM A 1987, 258:3411- -34163416
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Concl u sionConcl u sion
1. Early detection and correct diagnosis1. Early detection and correct diagnosisin early stages can be beneficial of:in early stages can be beneficial of:
T reatment efficacyT reatment efficacyPreventing costly and inappropriatePreventing costly and inappropriatetreatment resulting from misdiagnosistreatment resulting from misdiagnosis
Giving patients and families time toGiving patients and families time toprepare for the challenging financial, legal,prepare for the challenging financial, legal,and medical decisions that may lie aheadand medical decisions that may lie ahead
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Concl u sionConcl u sion
2. T he best diagnostic test is a careful2. T he best diagnostic test is a carefulhistory, physical and mental statushistory, physical and mental statusexamination by a physician with aexamination by a physician with aknowledge of and interest in dementiaknowledge of and interest in dementia
and the dementing disease. Such anand the dementing disease. Such anevaluation is time consuming, but evaluation is time consuming, but nothing can replace it nothing can replace it
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Dementia, operationDementia, operation
definitiondefinitionSyndrome of multiple acquired cognitiveSyndrome of multiple acquired cognitive
deficits that sufficient to interfere withdeficits that sufficient to interfere witheveryday activitieseveryday activities
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Dementia, diagnostic criteriaDementia, diagnostic criteria
NINCDSNINCDS--ADRDA ADRDA andand DSMDSM--IV criteriaIV criteria(any two of the five below) (memory +any one below)(any two of the five below) (memory +any one below)
1. Memory impairment *1. Memory impairment *2. Aphasia (language disturbance)2. Aphasia (language disturbance)3. Agnosia (impaired recognition/knowledge)3. Agnosia (impaired recognition/knowledge)4. Apraxia (disability in performance of previously4. Apraxia (disability in performance of previously
learned skills or tasks)learned skills or tasks)5. Executive dysfunction5. Executive dysfunction
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Laboratory testingLaboratory testing
UrinalysisUrinalysisComplete blood count, ESRComplete blood count, ESR
Liver enzymesLiver enzymesBUN, creatininBUN, creatininElectrolytes, blood glucoseElectrolytes, blood glucose
Vitamin B12, folic acid Vitamin B12, folic acidT SH, free thyroid indexT SH, free thyroid indexSyphilis serology, HIV testing, ApoE?Syphilis serology, HIV testing, ApoE?
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Pilihlah jawaban yang paling tepat, yang sesuai dengan perasaaanPilihlah jawaban yang paling tepat, yang sesuai dengan perasaaan
anda dalam satu minggu terakhir.anda dalam satu minggu terakhir.
11 .. Apakah Apakah andaanda sebenarnyasebenarnya puaspuas dengandengan kehidupankehidupan anda?anda? YaYa TIDAKTIDAK
22.. Apakah Apakah andaanda telahtelah meninggalkanmeninggalkan banyakbanyak kegiatankegiatan
dandan minatminat atauatau kesenangankesenangan anda?anda? YA YA TidakTidak
33.. Apakah Apakah andaanda merasamerasa kehidupankehidupan andaanda kosong?kosong? YA YA TidakTidak
44.. Apakah Apakah andaanda seringsering merasamerasa bosan?bosan? YA YA TidakTidak
55.. Apakah Apakah andaanda mempunyaimempunyai semangatsemangat yangyang baikbaik setiapsetiap saat?saat? YaYa TIDAKTIDAK66.. Apakah Apakah andaanda takuttakut bahwabahwa sesuatusesuatu yangyang burukburuk akanakan
terjaditerjadi padapada anda?anda? YA YA TidakTidak
77.. Apakah Apakah andaanda merasamerasa bahagiabahagia untukuntuk sebagiansebagian besar besar hiduphidup anda?Yaanda?Ya TIDAKTIDAK
SK AL A DEPR ESI GERI ATRI K 15SK AL A DEPR ESI GERI ATRI K 15
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Cognitive ProgressionCognitive ProgressionClinical Dementia RatingPresymptomatic
CDR 0.5 CDR 1 CDR 2 CDR 3Neuropsychological
Functional
Time (years )
P r o g r e s s i o n
d d f ff
MCI