BAO CAO TONG QUAN k.
Mgt sd nhan xet ve Chung sa sut tri tue a Viet Nam
PGS.TS. Nguyen ChUtAig Hdi Than hnh hoc ViSlNam
I. KHAI NIEM CHUNG
La tap chuTig cua Than kinh lao khoa, va cung la phan muc cua Than kinh thoai hoa.
La bieu hien roi loan tam ly, roi loan sU thfch Lftig trong ddi song hang ngay va xa hgi.
Roi loan cac chiifc nang cao cap d v6 nao 6 nhieu mufc do, nhieu tang khac nhau.
II. TRANG B! KIEN THUnC
- Ngay tii nam 1974, BS. Nguyen Quoc Anh Chu nhiem Khoa-Bp mon Than kinh da co chuong trinh boidUcfng cac chuyen deve Than kinh tmh vi cho cac Bac si lau nam - Sa sut tri tue benh Alzheimer da dUcJc BS. Anh de cap tdi... Cung thdi gian nay, bac sy Anh da danh mgt so buoi de trinh bay va nhan xet mpt so tet Than kinh tam ly.
- Hpi nghi khoa hpc cua Vien Than kinh hpc Hoa Ky to chiifc nam 1993 tai New York co hpi thao ve Alzheimer Chung tfli co co hpi dUpc tham gia va duoc linh hoi them ve hinh cinh hpc nao cung la bleu hien sinh hoa cCia loai benh nay.
"Tif' ARICEPT da dUOc "biet" cf Viet Nam vao thang 11 nam 1996
- Dac biet, thang 11 nam 1997, Lanh dao Khoa Than kinh Benh vien Bach Mai da phoi hop vcfi To chifc nghien cCfu Benh Alzheimer Phap, GS. Francois Boiler to chCfc Hpi thao ve Benh Alzheimer lan thijf nhat (hpi trUdng Benh vien Bach Mai ngay 29 thang 11 nam 1997).
H'inh 1. BS. Nguyen Chitang ciing vdi Dgi bleu Canada taikhuonvienhanghiklToahoccua/WJtgiNewYoric
- Cac bao cao tong quan, cac Hpi th^o ve chiifng - benh nay dUdc trien khai dc^ 3 mien nhat la Ha Npi,Thai Nguyen, Da Ning, TP. Ho Chi Minh va Can TliO.
IN. CAC OE TAI NGHIEN CUU
Md dau, CO nhieu buoi sinh hoat khoa hoc d Ha Npi, Tp. Ho Chi Minh, d quan y la nhOfng buoi gidi thieu cac ca lam sang ve Sa sut tri tue kha nghi Alzheimer (vi du ca lam sang cua Thac sT BachThanhThuy).
Cac de tai nghien cLlli tap trung vao Sa sut tri tue mach mau, Sa sut tri tue sau sang chan sp - vdi cac luan an Thac sT, luan an Tien sT.... to chUc tai Khoa - Bd mon Than kinh, Oai hpc Y Ha Npi va Benh vien Bach Mai, tai Khoa Than kinh, Hpc vien Website: hoithankinhhocvietnam.com.vn S6 10/2014 I THAN KINH HOC VIET NAM 7
A BAO CAP TONG QUAN
Hmh 2. Hpi thao ve benh Alzheimer Idn thif 1 tgi Benh vien Bach Moi
Quan y va Vien nghien ciiu Y Dupc Lam sang 108 vaDai hpc Y thanh pho Ho Chi Minh.
Tat ca da dang d cac Dac san, cac Ky yeu cong trinh, cac Tap san va Tap chiThan kinh hpc Viet Nam.
IV. MOT SO KHO KHAN, HAN CHE TRUNG NGHIEN COU C H O N G SA SUT TRf TUE
1. Sa sut tri tue la mot van de lam cua Than kinh hoc, Tam than hoc, cua Lao khoa, Tham do chuTc nang va Phuc hoi chufc nang
1.1. Khdn tnf(mg Phdn dinh Suy giam nhan thvtc nhe &ngUdi binh thu^g va ngUdi benh ?
d ngddi cao tuoi, thudng tU 60 tuoi trd len, cd thoai hoa myelin, cac cd quan chdc nang (tim, phoi, gan..., giac quan...) giam hoat dpng..." mat md, chan cham, ngh^ng ngang, de cam xuc va dac biet la Quen - roi loan tri nhd vdi nhieu the loai. Cdthe quen do roi loan qua trinh ghi nhd, do roi loan qua trinh luu trd hay do roi loan qua trinh hoi Uc. Cd the gap ngudi cao tuoi hoac ngUdi benh vdi hien tupng "noi trUdc quen sau" tham chi"an roi lai keu la chUa an"... Co the cd mat djnh hudng ve thdi gian hay ve khong gian: ngudi benh khong phan biet "nda dem tlnh giac di tap
the due vi keu la da san9....cd ngudi b&nh quen khong nhd dUdng di ve nha ... Tuy nhien, "ngudi benh" lai rat nhd chuyen xUa...
Cd the "ngUdi benh" thay khd khan theo doi ghi nhd nhOng "viec" qua dai phat thanh, qua truyen hinh.
Cd the ngUdi benh khflng nhd nhOng ngay ky niem (sinh nhat cua ban than, ngay quoc khanh...).
Cd the trflng thay ngUdi thSn nhUng "ngudi benh" khdng nhan ra la ai.
Cd the "ngudi benh" khdng bi^t cai khuy ao, quen sU dung cac dpng tac trong sinh hoat hang ngay, cung nhu cac dpng tac nghe nghiep...
Cac bieu hien tren cua suy giam nhan thUc nhe cd the la binh thudng d ngUdi cao tu6i, cfl the trd thanh benh ly vdi quen ngay cang nang ne vdi nhCfng roi loan cam xuc (tinh cSm thd d, con hUng tram cam...), roi loan ngon ngCf (that ngdn = mat ngdn), roi loan thUc van (mat thuc van), roi loan tri giac {mat tri giac) bieu hien 6 nhieu mUcdpcuaSa sutTrftue.
Sa sut tri tue - tiiy theo nguyen nhan cd the cd ton thUdng 6 vung tran, d vung thai dUong, d vung ben dUdi thuy thai dUong.
Tiiy vj tri tdn thUdng nao, cd trudng hpp Sa sut trf tue lai cd con lii lan, mat djnh hudng, roi loan trddng lUQ... roi loan tam than,... dac bi^t cd trddng hpp cdDong kinh.
2. Dua theo tieu chi chan doan Sa sut trf tue theoDSM4...,DSM5
2.7. Phan dinh cdc chiJtng sa siit tri tue Cd tdi 70 chUng benh gay sa sut tri tue.
+ Roi loan chuyen hoa, roi loan dinh dudng.
+ Ngp doc thuoc man tinh - sd dung thuoc an than khong dimg chi djnh, keo dai va qua lieu.
+ Sang chan sp, nhat la hien nay sang chan sp trong tai nan giao thdng....
+ Nhiem trung do giang mai, benh AIDS.
8 THANKINHHOCVIETNAMI SO 10/2014 Website, hoithankinhhocvietnam.com.vn
BAO C A O T O N G Q U A N k.
Hmh 3. Sodo Broadmann & mat ngodi vd mat trong cua vo ndo.
+ Viem nao d tre em va viem nao d ngUdi Idn.
+ Dac biet cac benh Thoai hoa d nao - nhat la cac loai benh Alzheimer, Nhoi mau da 6..., Hon h o p benh Alzheimer va Nhoi mau da 6.
2.2.Ve dieu tri
Nan giai vi cd kha nhieu ly thuyet ve cd che, tac d p n g thuoc...
Mat khac, sd d u n g thuoc cdn ban che vi tinh da benh ly cung n h u y e u chju d u n g d ngudi gia.
2.3. Con khd nhieu "lo hong" trong lanh vi/c dao tgo chuyen khoa
Chua cd npi d u n g chUdng trinh dao tao sau va tren dai hpc cho ca nddc veThan kinh tinh vi, ve Than kinh tam ly lam sang.
2.4. Mgt so bdc si tre biin nay-nhdt tacf cdc phong kham, benh vien tU nhdn qud thien ve phttang tien Tham do chCtc ndng
Khong kham lam sang ma cho ngudi benh
Website: hoithankinhhocvietnam.com.vn
"di xi t i " cho ngddi benh di chup cat Idp vi tinh sp nao.
2.5. Chitng benh Sa Sdt Tri Tue Alzheimer con nhieu bihiem
Trudng hpp Ronald Reagan - vj Tong thong t h U 4 0 cua Hoa Ky vdi 2 nhiem ky 1981 - 1989.
Con trai dng ta la Ron Reagan da cho hay la ngay nhiem ky 1, Tong t h o n g da cd bieu hien benh...
Het nhiem ky 2, biet benh cua mlnh, Reagan da than: "di den diem den Hoang hdn cupc d d i "
.... va tiep tuc chong d d vdi benh trong 10 nam...
Ronald Reagan chet d tuoi 92 do bj bien chdng viem phoi nang
Nancy Reagan, phu nhan ciia Ronald Reagan da thanh lap Hpi TUdng trp Benh Alzheimer de giup d d ngudi mac benh nay...
3. HUdng t d i tUcfng lai
"The ky 21 la The ky ciia TU duy" (GS. Dang Van Chung...).
Thap ky cua Nao (Decade of the Brain - DOB) 1990-2000 cua G. Bush da qua vdi nhieu thanh qua nghien cdu ve Nao da dKSgc cdng bo qua cac sach bao, cac hoi nghi khoa hoc cua Than kinh hpc Hoa Ky...
Ngay 5 thang 4 nam 2014, Tong t h o n g Hoa Ky B. Obama vdi Tuyen bo BRAIN Initiative tdc la Brain Rearch through Advancing Innovative Neurotechnologies Initiative (Nghien cdu Nao hoan chinh qua cac Ky thuat than kinh tien tien).
T d d d , cac Trung tam nghien cdu nao, cac Vien Than kinh d Hoa Ky da tiep tuc hoac khdi dau nghien cdu nhdng vung dac biet d Nao.
Nghien cdu gen hpc va Ung d u n g te bao goc t r o n g dieu trj benh Alzheimer...
20/9/2014 S 6 10/2014 I THAN KINH HOC VIET NAM 9