M

C
I
inimal
ognitive
mpairment
syafruddin yunus
2 Neurological Function
1. Hard neurological Functunction
Walking,Talking, hearing, balancing,
urine, eating, etc
2. Soft neurological function
neurobehavioural function ( languange,
memory, visuospatial, atention, cognitive)
4
STIMULUS INTRINSIK / EKSTRINSIK



FUNGSI LUHUR


SDM
KUALITAS
IPTEK / IMTAK
DERAJAT MAHLUK
SURVIVAL
PENDAHULUAN
5

Mahar Mardjono :FL adalah suatu fungsi pada manusia
yang mengolah dan mengintegrasikan
persepsi secara adekwat
Lezak : . Is an applied science concerned with
the behavioural expression of brain dysfunction
DEFINISI
Cognitive Function
The best function of neurobehaviour
Sublimation of other neurobehaviour
function
Excecutive functions ; thinking, opinion,
manajemen, solving the problems, wise,
human quality.
Introduction
MCI is a phase of brain decline
High risk of developing Alzheimer (type
dementia )
No uniform definition
Prevalence ; 2 -30% in general population
( Indonesia : no data )
General concept ; cognitive impairment
but not demented.

BRAIN DECLINE SEQUENTIAL
IN ELDERLY
SENESCENCE ( Fisiological )
SENILITY ( In-between group)
DEMENTIA ( Pathological)
SENESCENCE ( Fisiologis)

Signed by forgetfulness.
Kral (1958) : Benign Senescent Forgetfulness (BSF)
Crook (1986) :Age Associated Memory Impairment
(AAMI)
Prevalence :
35% in > 65 th age (Lane& Snowdown 1989)
39% in 59 - 60 th & 85% in >80 th age
(Larabe & Crook 1994)
DEMENTIA ( Pathological )
Signed by minimal 3 neurobehavior function
impairment ( 5 )
Predominant memory impairment
Demented
Ironic : Demented is usual in elderly
Is a medical illness

SENILITY ( In-between group)
Signed by actual memory impairment without
demented
Mild Cognitive Disorder (MCD) 1993, ICD 10 WHO
Mild Neuro Cognitive Disorder (MNCD) 1994, Levy
Cognitive Impaired Not-Demented (CIND) 1995,Ebly
Mild Conitive Impairment (MCI) 1996, Smith
Definition and terminology
Operationalized : the presence of cognitive
impairment that is not severe enough to meet
the criteria of dementia
More than 40 definitions (2004)
6 major concepts based on :
Cognitive complaints only
Mild functional impairment only
Cognitive tests impairment only
Combination of cognitive & tests impairment
Combination mild functional & tests impairment
Mild functional tests impairment
MINIMAL COGNITIVE IMPAIRMENT
( M.C.I )
Reported for the first time in 1999 in Mayo Clinic
is a trantition phase to dementia
12% in a year , 50% in 3 years ,
80% in 8 years
Criteria :
- There is an actual memory impairment
reported by another person
- Abnormal impairment for age and education
- Normal ADL
- General cognitive function is normal
- Not demented



NEUROPATHOLOGy/ PATHOGENESIS
Brain organic disorders : frontotemporal lobe
atrophy
Microscopic : depend on underlying disease
Alzheimer Dementia : senile plaque - neurofibrile
tangles - neuronal loss.
Blood ; amyloid protein,tau protein
Neurotransmiter : Ach preparing disorder
Alzheimer Dementia : Ach <<


Causes of MCI
Similarly with Alzheimer dementia
MCI is a phase in continuum to Alzheimer
Diagnostic
Clinical sign & symptoms ( neurobehavior
function )
Examination
Neurological
Supporting examination
Neuropsikiatric tests
MMSE, GDS
Radiology
Imaging
Biochemical ( tau protein , Beta amyloid)
NORMATIVE
AGING
M C I
DEMENTIA
PATO.AGING
MMSE >24
GDS 1
MMSE 23-17
GDS 2
CONTINUUM
DEGRADASI KONDISI USILA
MMSE <18
GDS 3
Jenis Tatalaksana
NON FARMAKOLOGIS FARMAKOLOGIS

Psikososial
Stimulasi Kognisi
- Terapi rekreatif
= Reminisens
= Orientasi nyata
Latihan fisik & otak

ChE-I
Nootropik
Neuroprotektiv
NSAID
Estrogen
Simptomatik lain

Conclusion
MCI is a heterogenous condition
MCI is the risk for Alzheimer ( type dementia)
No standard criteria for MCI
MCI is not related to one spesific disorder
Combination of variable examination may be
useful to diagnose MCI
MCI should be considered as a syndome rather
than as a disease
The treatment in this phase is very benefit