{"id":2543,"date":"2017-11-20T16:01:00","date_gmt":"2017-11-20T16:01:00","guid":{"rendered":"http:\/\/iuliapasarin.ro\/?p=2543"},"modified":"2020-08-14T19:25:22","modified_gmt":"2020-08-14T19:25:22","slug":"boala-alzheimer","status":"publish","type":"post","link":"https:\/\/iuliapasarin.ro\/?p=2543","title":{"rendered":"BOALA ALZHEIMER"},"content":{"rendered":"<p><span style=\"color: #000000;\"><strong>BOALA ALZHEIMER<\/strong><\/span><span style=\"color: #000000;\"><strong>\u00a0<\/strong><\/span><\/p>\n<p><span style=\"color: #000000;\">Termenul \u201edemen\u021b\u0103\u201d deriv\u0103 din limba latin\u0103, <em>demens<\/em>, unde \u201ede\u201d = desp\u0103r\u021bire, departe \u0219i \u201emens\u201d = minte.<\/span><\/p>\n<p><span style=\"color: #000000;\">Pentru c\u0103 deseori apare o confuzie \u00eentre boala Alzheimer \u0219i demen\u021b\u0103, vom face o delimitare a acestor termeni \/ afec\u021biuni. \u201eDemen\u021bele reprezint\u0103 o clas\u0103 de afec\u021biuni neurodegenerative ale sistemului nervos caracterizate prin deteriorarea progresiv\u0103 \u0219i ireversibil\u0103 a func\u021biilor cognitive, a func\u021bion\u0103rii globale care poate evolua c\u0103tre invaliditate \u0219i moartea prematur\u0103 a persoanei\u201d. Demen\u021bele prezint\u0103 o \u201eevolu\u021bie progresiv\u0103 cu simptomatologie heterogen\u0103: tulbur\u0103ri de memorie, limbaj, dezorientare, tulbur\u0103ri de personalitate \u0219i de comportament (dezinhibi\u021bie sexual\u0103, tendin\u021b\u0103 la hetero- \u0219i autoagresivitate, tulbur\u0103ri ale ritmului somn-veghe)\u201d, <a href=\"http:\/\/iuliapasarin.ro\/?page_id=2768\">evaluarea neurocognitiva surprinde schimbarile<\/a>.<br \/>\n<\/span><\/p>\n<p><span style=\"color: #000000;\">Demen\u021ba produce o deteriorare major\u0103 \u00een func\u021bionarea intelectual\u0103 cu alterarea capacit\u0103\u021bii persoanei de a face fa\u021b\u0103 activit\u0103\u021bilor de zi cu zi \u0219i cotidiene.<\/span><\/p>\n<p><span style=\"color: #000000;\">Evaluarea \u00een vederea stabilirii prezen\u021bei sau absen\u021bei demen\u021bei trebuie s\u0103 fie una complex\u0103 care s\u0103 implice evaluarea psihiatric\u0103, neuropsiholgoic\u0103, imagistic\u0103 pentru a evita identificarea fals pozitiv\u0103.<\/span><\/p>\n<p><span style=\"color: #000000;\">Dementele sau tulburarile neurocognitive usoare si majore pot aparea in:<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\">Boala Alzheimer<\/span><\/li>\n<li><span style=\"color: #000000;\">Degenerescen\u021ba froto-temporal\u0103<\/span><\/li>\n<li><span style=\"color: #000000;\">Boala cu corpi Lewy<\/span><\/li>\n<li><span style=\"color: #000000;\">Boala vascular\u0103<\/span><\/li>\n<li><span style=\"color: #000000;\">Traumatismul cranio-cerebral<\/span><\/li>\n<li><span style=\"color: #000000;\">Consumul de substan\u021be sau medicamente<\/span><\/li>\n<li><span style=\"color: #000000;\">Infec\u021bie HIV<\/span><\/li>\n<li><span style=\"color: #000000;\">Boala prionic\u0103<\/span><\/li>\n<li><span style=\"color: #000000;\">Boala Parkinson<\/span><\/li>\n<li><span style=\"color: #000000;\">Boala Huntington<\/span><\/li>\n<li><span style=\"color: #000000;\">Alte afec\u021biuni medicale<\/span><\/li>\n<li><span style=\"color: #000000;\">Etiologii multiple<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 In faza u\u0219oar\u0103 a tulbur\u0103rii neurocognitive, boala Alzheimer se manifest\u0103 caracteristic prin deficit de memorie \u0219i \u00eenv\u0103\u021bare, \u00eenso\u021bite uneori de deficite ale func\u021biei executive. \u00cen tulburarea neurocognitiv\u0103 major\u0103 vor exista \u0219i deficite de integrare spa\u021bio-vizual\u0103 \/ perturb\u0103ri perceptivo-motorii \u0219i deteriorarea limbajului, \u00een special \u00een forma moderat\u0103 sau sever\u0103.<\/span><\/p>\n<p><span style=\"color: #000000;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Tratatele de specialitate definesc boala Azheimer ca fiind \u201eo boal\u0103 cerebral\u0103 degenerativ\u0103 primar\u0103, cu etiologie necunoscut\u0103, av\u00e2nd tr\u0103s\u0103turi caracteristice neuropatologice \u0219i neurochimice. Debutul este de obicei insidios \u0219i progresiv \u00een decursul mai multor ani. Aceast\u0103 perioad\u0103 poate fi scurt\u0103, de 2-3 ani, dar poate fi uneori considerabil de lung\u0103. Debutul poate avea loc la mijlocul vie\u021bii adulte, sau chiar mai devreme (boala Alzheimer cu debut presenil, in experienta de cabinet am intalnit persoane cu varsta de pana in 55 de ani care intruneau toate criteriile in ceea ce privete manifetarile clinice pentru dignosticul de Boala Alzheimer), dar inciden\u021ba este mai crescut\u0103 \u00een ultima parte a vie\u021bii (boala Alzheimer cu debut senil)\u201d. S-a observat c\u0103 atunci c\u00e2nd boala debuteaz\u0103 \u00eenaintea v\u00e2rstei de 64-70 de ani \u201cexist\u0103 posibilitatea unei istorii familiale de demen\u021b\u0103 similar\u0103, aceasta cu o evolu\u021bie mai rapid\u0103, o proeminen\u021b\u0103 a tr\u0103s\u0103turilor care sugereaz\u0103 o leziune a lobilor temporali \u0219i parietali, inclusiv disfazia \u0219i dispraxia\u201d. S-a mai observat c\u0103 atunci c\u00e2nd debutul este mai tardiv, evolu\u021bia este mai lent\u0103 \u0219i boala duce la deteriorarea mai global\u0103 a func\u021biilor corticale superioare.<\/span><\/p>\n<p><span style=\"color: #000000;\"><strong>\u00a0<\/strong><\/span><\/p>\n<p><span style=\"color: #000000;\"><strong>STADIILE BOLII ALZHEIMER<\/strong><\/span><\/p>\n<p><span style=\"color: #000000;\">Se disting urm\u0103toarele stadii evolutive<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\"><strong>Perioada prodromal\u0103<\/strong> caracterizat\u0103 prin prezen\u0163a unei alter\u0103ri progresive a memoriei (tulburarea amnestic\u0103) definit\u0103 \u00een literatur\u0103 ca Mild Cognitive Impairment. La examenul RMN se poate obiectiva hipoperfuzia cortexului prefrontal. Pot aparea u\u0219oare simptome la nivelul aten\u021biei, memoriei, orient\u0103rii spa\u021bio-temporale puse pe seama oboselii, v\u00e2rstei.<\/span><\/li>\n<li><span style=\"color: #000000;\"><strong>Stadiul incipient<\/strong> &#8211; Boala Alzheimer \u2013 forme u\u0219oare. <span style=\"color: #000000;\">Simptomul principal a fazei ini\u021biale este afectarea capacitatii de concentarare a atentiei, memoriei de scurt\u0103 durat\u0103, poate apara usoara dezorientare temporo-spatiala partiala, usoara tulbuare a capacitatii de reprezentare (posibila).<\/span><\/span><\/li>\n<li><span style=\"color: #000000;\"><strong>S<\/strong><strong>tadiul de evolu\u021bie medie\/moderat\u0103. <\/strong><\/span><span style=\"color: #000000;\">Tulburarile de concentare a atentiei, tulburarile de memorie se accentueaza, se accentueaza tulburarea de orientare temporo-spatiala, apar tulburarile in vorbire (dificultata de a intelege sensul cuvintelor sau de a se exprima &#8220;nu isi gaseste cuvintele&#8221;), pot aparea dificultati in diferite activitati motorii de coordonare, pot aparea dificultati in recunoaterea unor persoane familiale, apar tulbur\u0103ri ale func\u021biilor de organizare a activit\u0103\u021bilor zilnice, incapacitatea de a lua decizii.<\/span><\/li>\n<li><strong><span style=\"color: #000000;\">Stadiul de evolu\u021bie sever\u0103 (terminal\u0103).<\/span><\/strong> <span style=\"color: #000000;\"><span style=\"color: #000000;\">In acest stadiu toate functiile cognitive si de executie sunt grav afectate persoana vand nevoie de supraveghere si ajutor permanent.<\/span><\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000;\">Simptomelor neurocognitive enumerate mai sus li se pot alatura <strong>simptome non-cognitive<\/strong> cum ar fi Agita\u021bie \u0219i agresivitate fizic\u0103 sau verbal\u0103, Tulbur\u0103ri psihotice &#8211; halucina\u021bii, auditive \/ vizuale, idei delirante, Tulbur\u0103ri ale dispozi\u021biei afective, Dezinhibi\u021bie sexual\u0103 &#8211; comentarii pe teme sexuale, gesturi obscene, Incontinen\u021ba organelor de eliminare.<\/span><\/p>\n<p><span style=\"color: #000000;\">In stadiul incipiet pot fi absente sau prezente ocazional, dar pe masura ce boala evolueaza creste probabilitatea ca unele dintre aceste manifestar non-cognitive sa apara si sa se agraveze.<\/span><\/p>\n<p><span style=\"color: #000000;\">Este important de mentionat ca \u00een func\u021bie de nivelul de educa\u021bie, de coeficientul de inteligen\u021b\u0103 pacientul poate s\u0103 nu manifeste simptome cognitive clinice, de\u0219i imagistica arat\u0103 atrofie cerebral\u0103 specific\u0103 bolii Alzheimer.<\/span><\/p>\n<p><span style=\"color: #000000;\"><strong>\u00a0<\/strong><\/span><\/p>\n<p><span style=\"color: #000000;\"><strong>COEXISTEN<\/strong>\u021a<strong>A DEMEN<\/strong>\u021a<strong>EI DIN BOALA ALZHEIMER CU ALTE BOLI<\/strong><\/span><\/p>\n<p><span style=\"color: #000000;\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Demen\u021ba din boala Alzheimer poate coexista cu demen\u021b\u0103 vascular\u0103 c\u00e2nd episoade cerebro-vasculare (fenomene de multiinfarct) se suprapun pe un tablou clinic \u0219i un istoric ce sugereaz\u0103 boala Alzheimer. \u00cen conformitate cu constat\u0103rile post-mortem, coexisten\u021ba celor dou\u0103 tipuri apare \u00een 10-15% din toate cazurile de demen\u021b\u0103.<\/span><\/p>\n<p><span style=\"color: #000000;\"><strong>SINDROMUL DEMEN<\/strong><strong>\u021aIAL \u201c<\/strong>reprezint\u00e3 deteriorarea extrem\u0103 a persoanei, o cobor\u00e2re \u00een sindromul axial c\u0103tre limita de jos, adic\u0103 se coboar\u0103 de la inteligen\u021b\u0103 la absurd, la animalizare. Tabloul poate fi agravat \u0219i accelerat \u00een evolu\u021bie de episoade acute. Toate c\u0103ile deteriorative se vars\u0103 \u00een marele fluviu demen\u021bial al bolii Alzheimer, de aceea acest diagnostic pare uneori excesiv, abuziv, \u00eenainte de apari\u021bia fenomenelor neurologice (AAA). S-a ajuns s\u0103 se vorbeasc\u0103 de un pre-Alzheimer, pe un examen clinic de psihologie, etc\u201d \u2013 A. Romil\u0103, \u201cPsihiatrie\u201d.<\/span><\/p>\n<p><span style=\"color: #000000;\"><strong>\u00a0<\/strong><\/span><\/p>\n<p><span style=\"color: #000000;\"><strong>PSEUDODEMEN\u021aA<\/strong><\/span><\/p>\n<p><span style=\"color: #000000;\">Depresia este afec\u021biunea psihic\u0103 \u00een care apar al\u0103turi de tulbur\u0103rile non-cognitive \u2013 tulbur\u0103ri de somn, tulbur\u0103ri de alimentare \u0219i simptome cognitive \u2013 hipoprosexie, hipomnezie, dezorientare, flux ideativ-verbal \u00eencetinit. Factorii motiva\u021bionali sau emo\u021bionali, cum sunt cei din depresie, ca \u0219i lentoarea motorie \u0219i fragilitatea somatic\u0103 general\u0103, pot explica e\u0219ecul performan\u021belor (activit\u0103\u021bii) mai degrab\u0103 dec\u00e2t pierderea capacit\u0103\u021bii intelectuale.<\/span><\/p>\n<p><span style=\"color: #000000;\">In depresie putem avea simptome cognitive care \u00eens\u0103 sunt cauzate de o lips\u0103 a motiva\u021biei, de slab\u0103 capacitate de concentrare a aten\u021biei, de insuficient\u0103 odihn\u0103 datorat\u0103 tulbur\u0103rilor de somn, de aceea este nevoie de o investigare atent\u0103 pe toate planurile: psihiatric\u0103, psihologic\u0103, imagistic\u0103 pentru stabilirea diagnosticului \u0219i stabilirea tratamentului adecvat de c\u0103tre medic.<\/span><\/p>\n<p><span style=\"color: #000000;\"><strong>\u00a0<\/strong><\/span><span style=\"color: #000000;\"><strong>EXAMENUL NEUROPSIHOLOGIC <\/strong><\/span><\/p>\n<p><span style=\"color: #000000;\">Al\u0103turi de examenul neurologic, psihiatric, examenul de laborator, imagistic\u0103, examenul neuropsihologic, \u201etrebuie s\u0103 fac\u0103 parte din examinare \u00een mod obligatoriu \u00een cazurile de demen\u0163\u0103 usoar\u0103 sau probabil\u0103, cu aplicarea de teste pentru aprecierea deficitului cognitiv ca \u0219i scale specifice pentru evaluarea depresiei (uneori depresia poate mima o demen\u0163\u0103 sau se poate asocia unei demen\u0163e).<\/span><\/p>\n<p><span style=\"color: #000000;\"><strong>PLASTICITATEA RE\u0162ELELOR NEURONALE IMPORTAN\u0162A <\/strong><strong>\u00ceN DEZVOLTARE \u0218I RECUPERARE<\/strong><\/span><\/p>\n<p><span style=\"color: #000000;\">Plasticitatea re\u0163elelor\u00a0 neuronale sau neuroplasticitaeta este \u00a0definit\u0103 ca fiind \u201eabilitatea creierului de a-\u0219i reorganiza neuronii pentru a forma noi conexiuni neuronale pe baza \u00eenv\u0103\u0163\u0103rii \u0219i a experien\u0163ei de via\u0163\u0103\u201d (C. B\u0103l\u0103ceanu Stonici).<\/span><\/p>\n<p><span style=\"color: #000000;\">Se pot organiza sedinte de stimulare cognitiva pentru persoanele diagnosticate cu boala Alzheimer in stadiu incipient, iar gratie neruoplasticitatii se pot ameliora unele manifestari clinice si prelungii functionalitatea persoanei.<\/span><\/p>\n<p><span style=\"color: #000000;\">Resurse:<\/span><\/p>\n<p><span style=\"color: #000000;\">DSM \u2013 V, 2016; ICD-10; \u201ePsihiatrie\u201d \u2013 prof. Dr. A. Romila, \u201eNeurologie \u2013 notite de curs\u201d \u2013 acad. C. Balaceanu Stolnici; Petersen, 2004; Braak, 1999<\/span><\/p>\n<p><span style=\"color: #000000;\"><strong>\u00a0<\/strong><\/span><span style=\"color: #000000;\"><strong>Multumesc domnului profesor Aurel Romila<\/strong> pentru coordonara lucrarii de disertateie \u201eEvaluarea neuropsihologic\u0103 \u0219i stimularea cognitiv\u0103 a persoanelor diagnosticate cu boala Alzheimer cu debut precoce\u201d<\/span><\/p>\n<p><span style=\"color: #000000;\"><a href=\"http:\/\/iuliapasarin.ro\/?page_id=2\" target=\"_blank\" rel=\"noopener noreferrer\">Iulia Pasarin <\/a>\u2013 psiholog clinician si psihoterapeut integrativ specialist<\/span><\/p>\n<p><span style=\"color: #000000;\">Aveti nevoie de o <a href=\"http:\/\/iuliapasarin.ro\/?page_id=2768\">evaluare<\/a>?<\/span><\/p>\n<p><span style=\"color: #000000;\">\u00a0Puteti face o programare la numarul de telefon 0728.967.011<\/span><\/p>\n<p><span style=\"color: #000000;\">Materialul poate fi preluat cu mentionarea sursei.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>BOALA ALZHEIMER\u00a0 Termenul \u201edemen\u021b\u0103\u201d deriv\u0103 din limba latin\u0103, demens, unde \u201ede\u201d = desp\u0103r\u021bire, departe \u0219i \u201emens\u201d = minte. Pentru c\u0103 deseori apare o confuzie \u00eentre boala Alzheimer \u0219i demen\u021b\u0103, vom face o delimitare a acestor termeni \/ afec\u021biuni. \u201eDemen\u021bele reprezint\u0103 o clas\u0103 de afec\u021biuni neurodegenerative ale sistemului nervos caracterizate prin deteriorarea progresiv\u0103 \u0219i ireversibil\u0103 a &hellip; <\/p>\n","protected":false},"author":1,"featured_media":1708,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[264,538,575,398,23,576,22,577],"_links":{"self":[{"href":"https:\/\/iuliapasarin.ro\/index.php?rest_route=\/wp\/v2\/posts\/2543"}],"collection":[{"href":"https:\/\/iuliapasarin.ro\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/iuliapasarin.ro\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/iuliapasarin.ro\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/iuliapasarin.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2543"}],"version-history":[{"count":4,"href":"https:\/\/iuliapasarin.ro\/index.php?rest_route=\/wp\/v2\/posts\/2543\/revisions"}],"predecessor-version":[{"id":3375,"href":"https:\/\/iuliapasarin.ro\/index.php?rest_route=\/wp\/v2\/posts\/2543\/revisions\/3375"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/iuliapasarin.ro\/index.php?rest_route=\/wp\/v2\/media\/1708"}],"wp:attachment":[{"href":"https:\/\/iuliapasarin.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2543"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/iuliapasarin.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2543"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/iuliapasarin.ro\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2543"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}