Hafif kognitif bozukluğunun Alzheimer hastalığı ve vasküler demans temelinde araştırılması
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2013
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Maltepe Üniversitesi, Tıp Fakültesi
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CC0 1.0 Universal
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Özet
Amac: Hafif kognitif bozukluk (HKB) saglıklı yaslanma ile demans arasında yer alan patolojik bir evre olarak ifade edilir. Bireyin gundelik yasamında belirgin bir sorunun olmadıgı evredir. Demans gelisimi acısından belirgin risk tasıyan HKB olgularının iyi tanınması, ayrıntılı norokognitif testlerle erken tanısının konulması ve tedavinin baslanılması son derece onemlidir. Bu calısmada, HKB olguları; erken evre Alzheimer hastalıgı (AH), vaskuler demans (VD) ve selim yaslılık unutkanlıgı (SYU) olguları ile kognitif profil, gunluk yasam aktiviteleri ve depresyon acısından karsılastırılmıs, HKByi SYUdan ve diger demans tiplerinden ayırabilecek farklılıkların saptanması amaclanmıstır. Materyal ve Metod: Calısmaya poliklinige unutkanlık yakınması ile basvuran ve HKB, SYU, erken evre AH ve VD olcutlerini karsılayan 50 yas ustu okuma yazma bilen bireyler, yas cinsiyet ve egitim duzeyi acısından farklılık gostermeyecek sekilde retrospektif olarak alınmıstır. Tum olgulara Wechsler bellek olcegi (WBO) parametrelerinden; WBO-I: Kisisel ve guncel bilgiler, WBO-II: Oryantasyon, WBO-III: Geri sayımlar, WBO-V: Sayı menzili, WBO-VI: Gorsel bellek testi yapılmıstır. Ayrıca tum olgulara saat cizimi testi, stroop testi, Benton yuz tanıma testi, Boston adlandırma testi ve mini mental durum testi (MMDT), geriatrik depresyon olcegi (GDO) ve gunluk yasam aktiviteleri (GYA) olcegi uygulanmıstır. HKB grubu ile SYU ve diger demanslar arasında, kognitif test, gunluk yasam aktiviteleri ve geriatrik depresyon olcegine gore ikili karsılastırmalar yapılmıstır. Sonuclar: HKBde SYU olgularına gore karmasık dikkat testlerinde; uzun sureli bellek testlerinde; yurutucu fonksiyonlardan; soyutlama, kelime akıcılıgı ve uygunsuz cevabın inhibisyonunu olcen teslerde bozulma saptandıgı, gunluk yasam aktiviteleri acısından fark olmadıgı saptanmıstır. Erken evre AH olgularında HKBye gore bellek testlerinde ve yurutucu fonksiyonlarda bozulmanın on planda oldugu saptanmıstır. VD olgularında HKBye gore lisan islevleri, gorsel-mekansal islevler ileri derecede etkilenmis olarak bulunmustur. VD grubunda tum gruplara gore, depresyon testlerinde istatistiksel olarak yuksek puanlar saptanmıstır. Tartısma: Calısmamızda kullanılan norokognitif testler; hafif kognitif bozuklugun SYUdan ve diger demans turlerinden ayrımında onemli ipucları saglamıstır. Selim yaslılık unutkanlıgı ile izledigimiz bir kiside oryantasyonda bozulma ve geri sayı menzili gibi dikkat gerektiren testlerde zorlanma basladı ise HKBye ve AHye gidis olabilecegi akla getirilmelidir. Bu bozulmalar daha cok dil ve gorsel mekansal islevlerde gerceklesiyor ve olgularda depresyon belirgin olarak saptanıyor ise tanı vaskuler demans lehine degerlendirilebilir. Daha genis hasta grupları ve noroanatomik korelasyonları da iceren ileri calısmalar gereklidir.
Aim: Mild cognitive impairment (MCI) is defined as a pathological stage between ?healthy aging? and ?dementia? without individual daily life problem. Detailed neurocognitive tests for early diagnosis of MCI patients who had significant risk for the development of dementia are extremely important. In this study, cases of MCI were compared with early-stage Alzheimer's disease (AD), vascular dementia (VD) and benign senescent forgetfulness (BSF) cases in terms of cognitive profiles, activities of daily life and depression. It is aimed to define differentiations of MCIs from BSF and other types of dementia. Material and Method: Patients who had similar age and sex, applied to the outpatient clinic with the complaints of forgetfulness, who met the criterias of MCI, BSF, early- stage AD and VD and are over 50 years old were included retrospectively in the study. WMS (Wechsler memory scale)-I: personal and current informations, WMS-II: Orientation, WMS-III: Counting backwards, WMS-V: Digit span, WMS-VI: Visual memory tests were applied to all subjects. Additionally, clock drawing test, stroop test, Benton face recognition test, Boston naming test, mini?mental state examination (MMSE) test, geriatric depression scale (GDS) and activities of daily living scale (ADLS) were applied all patients. Results: Impairements in MCI cases were detected compared BSF cases by the complex attention tests, long-term memory tests, and abstraction, word fluency, and inhibition of inappropriate responses from executive functions. However, there were no significant differences between the MCI and BSF cases in terms of activities of daily living. Patients with early-stage AD, the deterioration of memory and executive function tests were found to be at the forefront, compared with MCI. According to MCIs, we found that the visual- mini?mental state examination (MMSE) test, geriatric depression scale (GDS) and activities of daily living, scale (ADLS) were applied spatial and language functions were severely affected in the patients with VD. The VD group had the highest depression scores among the all groups. Discussion: Neurocognitive tests used in this study, provided important tips in order to differantiate mild cognitive impairment from dementia and BSF. A patient with a follow up benign senescent forgetfulness starting to have difficulties in tests of orientation and the tests like backward digit span which requires attention, might be a progression toward MCI and AH. If these deteriorations are mainly in language and visual spatial functions and depression is determined to be significant, diagnosis can be in the favor of vascular dementia. Further studies included neuroanatomical correlations and larger patient groups are needed.
Aim: Mild cognitive impairment (MCI) is defined as a pathological stage between ?healthy aging? and ?dementia? without individual daily life problem. Detailed neurocognitive tests for early diagnosis of MCI patients who had significant risk for the development of dementia are extremely important. In this study, cases of MCI were compared with early-stage Alzheimer's disease (AD), vascular dementia (VD) and benign senescent forgetfulness (BSF) cases in terms of cognitive profiles, activities of daily life and depression. It is aimed to define differentiations of MCIs from BSF and other types of dementia. Material and Method: Patients who had similar age and sex, applied to the outpatient clinic with the complaints of forgetfulness, who met the criterias of MCI, BSF, early- stage AD and VD and are over 50 years old were included retrospectively in the study. WMS (Wechsler memory scale)-I: personal and current informations, WMS-II: Orientation, WMS-III: Counting backwards, WMS-V: Digit span, WMS-VI: Visual memory tests were applied to all subjects. Additionally, clock drawing test, stroop test, Benton face recognition test, Boston naming test, mini?mental state examination (MMSE) test, geriatric depression scale (GDS) and activities of daily living scale (ADLS) were applied all patients. Results: Impairements in MCI cases were detected compared BSF cases by the complex attention tests, long-term memory tests, and abstraction, word fluency, and inhibition of inappropriate responses from executive functions. However, there were no significant differences between the MCI and BSF cases in terms of activities of daily living. Patients with early-stage AD, the deterioration of memory and executive function tests were found to be at the forefront, compared with MCI. According to MCIs, we found that the visual- mini?mental state examination (MMSE) test, geriatric depression scale (GDS) and activities of daily living, scale (ADLS) were applied spatial and language functions were severely affected in the patients with VD. The VD group had the highest depression scores among the all groups. Discussion: Neurocognitive tests used in this study, provided important tips in order to differantiate mild cognitive impairment from dementia and BSF. A patient with a follow up benign senescent forgetfulness starting to have difficulties in tests of orientation and the tests like backward digit span which requires attention, might be a progression toward MCI and AH. If these deteriorations are mainly in language and visual spatial functions and depression is determined to be significant, diagnosis can be in the favor of vascular dementia. Further studies included neuroanatomical correlations and larger patient groups are needed.
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Batum, K. (2013). Hafif kognitif bozukluğunun Alzheimer hastalığı ve vasküler demans temelinde araştırılması / Investigation of mild cognitive impairment on the basis of Alzheimer's disease and vasculer dementia (Yayımlanmamış Uzmanlık Tezi). Maltepe Üniversitesi, Tıp Fakültesi, İstanbul.
