A BAO CAO TONG QUAN
Chan doan va dieu trj sa sut tn tue Alzheimer hien nay
TS. BS.Tran Cong Thing Giang vien bo mdn Than kinh, Dgi hoc YDuac TP. HCM
T6MTAT
Theo th6ng ke gan day, trong khi ti^ le tdvong do cac benh ly thddng g^p nhu ung thutuyen ti^n li?t (-8%), benh tim (-16%), dot quy (-23%), va HIV (-42%) ngay cdng gidm, ty 1^ tOrvong do SSTT l^i khong ngimg gia tang (68%).^Trudc thuc trang dd, nhi^u nghien curu da dirpc thi^c hi^n nhdm edi ti^n cdc tieu chu^n chan doan va gia tang hieu qud di^u trj SSTT.
I. CAC TIEN BO TRONG CHAN DOAN SA SUT TRi THE
SSTT CO bieu hien rat da dang tren lam sang nhu giam tri nhd, mat ngon ngCr, roi loan dinh hU'dng, mat kha nang phan doan tu* duy, tram cam, lo au, rdi loan hanh vi tam than,...
Trong do, giam tri nhd tlnh tiet la bleu hien ban dau cua SSTT. LUu y la cac bieu hien tren lam sang van la tieu chuan chu yeu de chan doan SSTT. Tuy nhien, neu chi dua vao lam sang thi da so benh nhan se duoc chan doan khi benh da 6 giai doan trung binh - nang. Oay la mpt trd ngai Idn cua viec dieu tri. Vdi sii tien bo cua khoa hgc ky thuat, ngay nay SSTT da dupc phat hien la mot benh ly tien trien theo tUng bac (Hinh 1 ).^
Vdi SUxuat hien cua cac [3 amyloid va tau protein bat thudng trUdc khi c6 cac trieu chiJng tren lam sang, SSTT da cd the dupc chan doan sdm hdn nhd cac chat danh dau sinh hpc.
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Hinh /. Chi ddu sinh hpc vd cdc giai doan tien trien cua sa sOt tri tue Cactieu chuan chan doan SSTTnhUtieu chuan cua Hpi Lao khoa Quoc Gia va Hiep hoi Alzheimer (National Institute on Aging and Alzheimer's Association - NIA-AA) nam 2011, va mdi day nhat la tieu chuan cCia IWG-2 (International Working Group) nam 2014, da dua them mot so xet Website: hoithankinhhocvietnam.com.vn
BAO C A O T O N G Q U A N I
nghiem can lam sang vao tieu chuan chan doan xac dinh SSTT. Cac phUOng phap xet nghiem nay g o m CO d o nong do protein PA42 va protein tau trong djch nao tuy, MRl {danh gia mUc dp teo nao qua thang diem MTA), PET scan (phat hien cac mang amyloid [amyloid PET], dam roi spi than kinh [tau PET], va k h ^ nang sCrdung glucose cua nao [FDG PET]), va cac xet nghiem phat hien gien dot bien. Trong so do, sU hien dien cua gien dot bien, giam nong d o protein [3A42, tang nong dp protein tau, amyloid PET, tau PET la cac chi dau de chan doan xac dinh SSTT; con MRl cau true va FDG PET la chi dau cho qua trinh dien tien benh.''
II. CAP NHAT DIEU TRI SA SUT TRI TUE HIEN NAY
C h o d e n n a y , n h 6 m U c che men cholinesterase van la thuoc dupc lua chpn hang dau de dieu tri cho benh nhan SSTT.^ Khong chi t r o n g giai doan nhe va t r u n g binh, viec tiep tuc dCing Uc che men cholinesterase t r o n g giai doan nang con giup cai thien hanh vi/chUc nang cho benh nhan SSTTva giam ganh nang cho ngUdi cham soc.
Donepezil la m p t Uc che men cholinesterase da dupc chUng minh co hieu qua dteu tri SSTT t o t d t a t ca cac giai doan benh. Cu the, donepezil giup cai thien t r i n h d va cac chUc nang nhan thUc hang ngay d giai doan nhe," cai thien hanh vi ro ret d giai doan t r u n g binh - nang,'-^va giam toe dp tien trien den mat kha nang thUc hien cac boat d p n g song hang ngay d giai doan nang.^
Vdi Ipi ich t U viec lam giam cac roi loan hanh vi, viec d u n g donezepll con giup giam cang t h i n g cho ngUdi cham sdc benh nhan, va benh nhan dupc o n d i n h tai nha lau han.^ Khong nhiJng the, donepezil con giup lam giam nguy co tien trien den SSTT tren benh nhan suy giam nhan thUc nhe CO trieu chUng tram c5m (Hinh 2).'°
Website: hoithankinhhocvietnam.com.vn
H'tnh 2. Nguy CO tien trien thdnh sa sut tri tue gidm ddng kednhom dung donepezil.
De giam tac d u n g ngoai y va tang kha nang d u n g nap cua benh nhan, cac thuoc nay t h u d n g dupc khdi dau vdi lieu thap va tang lieu dan.
LUu y la de cd hieu qua, cac thuoc Uc che men cholinesterase can dupc d u n g d u n g lieu khuyen cao, nen viec chinh lieu sau khi khdi trj la rat can t h i e t Trong n h o m Uc che men cholinesterase, donepezil la thuoc duy nhat cho den hien nay khong can chinh lieu sau khi khdi dau dieu tri, chi khi benh nhan khong dap Ung dieu trj sau mpt t h d i gian theo doi thi mdi can tang lieu donepezil len.
Ben canh cac trieu chUng dien hinh cua SSTT, roi loan hanh vi cung la m o t trieu chUng t h u d n g gap. Trong m p t s d trudng hpp, thuoc chong tram cam hay thuoc chong loan than cung cd the dupc d u n g de lam giam cac roi loan nay. Luu y rang, ngudi benh khong t h e kiem scat hay tranh dupc hanh vi cua hp. Vi vay can dieu chinh hanh vi cua benh nhan (tim yeu t d khdi phat de loai bd, va lam lech hudng hanh vl) trudc khi dung thuoc, va nen d u n g d lieu thap de han che cac tac dung ngoai y cho benh nhan.
Vdi viec phat hien ra cac chat danh dau sinh hpc, dieu tri muc tieu (hudng den amyloid va tau protein benh ly) cung dang la mpt hudng mdi dang duoc nghien cUu nham dieu trj sdm SSTT.
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A BAO CAO TONG QUAN
Tdm lai, SSTT la benh ly thoai hda than kinh lien quan den tuoi tac. Benh sCf, tham kham than kinh tdng quat va tam than kinh la cac yeu to rat quan trpng de chan doan SSTT tren lam sang.
Ben canh do, can lam sang, dac biet cac chat danh dau sinh hpc, cd vai trd khong nhd trong viec ho trp chan doan. Du da dUpc phat hien tU lau nhung cac thuoc Uc che men cholinesterase.
nhu donezepil, van la nhom thuoc chinh trong dieu tri SSTT. Hieu quS cua thuoc Uc ch^ men cholinesterase se cang cao khi thuoc dupc dung cang sdm. Dieu quan trpng la can phdng ngUa SSTT. Cho den nay, each tot nhat de phdng ngUa SSTT van la tranh cac yeu to nguy cd tim mach, giCf tinh than sang khoai, t$p the due dieu dp, an uong can bang va glQ cd the gpn gang.
TAlLlfUTHAMKHAO:
Alzheimer's Association. Alzheimer's & Dementia. 2014; 10:e47-e92 2. Jack Jr. CR, et al. Lancet Neurol. 2013; 12(2):207-l 6
3. Selkoe DJ. Science. 1997; 275(5300):630-31 Dubosis B. et al. Lancet Neuro 2014;13:614-29 Waldemar G, et al. Eur J Neurol. 2007; 14(1 ):e1 -26 Seltzer B,etal.>lrcftA;euro/.2004;61:1852-1856 Gauthier S, et al. Cuff/Wed Res Op;n. 2002;18:347-354 WinbladB, etal. tancet. 2006;367:1057-1065 Geldmacher DS, et al. J Am Geriatr Soc. 2003;51:937-944 10. Lu PH, et al. Neurology. 2009; 72:2115-21
