BAO CAO TONC QUAN k.
Sa sut tri tu§
PGS.TS. Nguyen Chydng Chii tich HOI Than kmh hoc Viet Nam
Sa Slit t r i tu§ (Dementia) la bieu hi^n rdi loan tam ly, roi loan sirthich umg trong ddl sdng hang ngay va ddi song xa h$i.
Tri nhd, djnh hudng \ifc, trCru ti/dng hod, kh^ nang hpc: Cdc chiJc ndng ngdn ngcr, nh^n thijrc, tri giac, thi/c v$n cung nhif cdc chirong trinh - ke hoach - s i p xdp, tat ch d^u it nhi^u bi rdi logn d nhOng miic do khde nhau.
Cd S0 HOAT DONG CUA CAC CHQIC NANG CAO CAPdvdNAO
Ta biet hosit dpng tam ly (tri nhd, ngdn ngii, tri giac, thgc van...) la thi hien sg hoat i3png cua cac chijfc nang cao cap d vd nao.
Cd sd cua hoat dong nay la diTa tren dac diem giai phau - chiic nang cua vd nao. (anh 1, anh 2, anh 3).
Anh 1. M4t ngoai vo nao
Website; hoithani<inhhocvietnarn com vn
Anh 2. Mat dudi vo nao Chung lo^ phat sinh
Dd la cd sd thd nhjit di nghien ciiu ch^c nang cua vo nao: Tif loai ca, xuat hiln "phac thao" cua nao - cung hoa de thich ling vdi ddi song... Tdi loii chim bay Itign c3n co thi giac tinh vl nen bat
s623-QUYI/2018ITHiUIKINHHgCVl|rNAM 13
A BAO CAO TONG QUAN
dSu CO td chdc vo nao mdi. Td loai an thit, nao phat trien, co them cac khe ranh nao tao thanh cac h6i nao.
"H6i nao hoa" lam tang dien tich vo nao len gap hai, ba lan.
O loai ngiidi, dien tich mat phang ciia vo nao chi CO 75.000 mm^: nhd cac ranh, dien tich tang toan bo la 220.000 mm^ (chifng 145.00 mm^ la dien tich an d cac ranh).
0 loai ngiidi, chi c6 20% la dien phong chieu, c6n 80% la dien lien hdp va do la trung tam cac bieu hien hoat dong than kinh cao cap.
Cath^phittri^n
Ngay td thang thii S'^ cua phoi, nao bat dSu co thiiy, CO h6i.
Thang thii 7"^ xuSt hien cac 1<^ 5'^, Idp 6'^ cua vo nao va thang thd 8'^ xuat hien cac Idp khac.
Khi sinh ra, nao chu'a co myelin hoa, hoat dong cua tre chiia hoan hao, mdi chi la m6t " vat dh non "chiia biet diing, biet di mdi chi la sinh vat th^ nhat".
Tai lieu thi^c nghiem
Thiic nghiem la phiidng phap nghien ciiu phong phu nhat va chac chan nhSt. Qua nhl^u phiidng phap thiic nghiem d cac loai theo b|c thang tiefn hoa, ngiidi ta xac dinh diidc ro hdn chiic nang vo nao.
Qua thiic nghiem "got vo nao", cho thay sinh v^t cang phat tri^n thi rdi loan cang ro ret, dcfi song sinh vat cang ngan ngui vdi 2 bilu hien Icfn:
mat tiep thu, mat nhan thiic dd vat va thd d vcft hoan canh, mat tat ca phan xa co dieu kien (chi tinh dJiy an u6ng va phai diia thiic an tan milng, v4t khong thef tti kilm mdi diidc).
Tai lieu cd th^ - l^m sing
Q day, chi de cap tdi nhiing "thilu sdt" cua nao cimg.
Thiidng chii y tdl hien hidng khdng nao (quai thai), nguHg phat trien va teo vd nao.
O mdt s6 tnidng hdp viem nao, vilm mang nao d tre em lam teo vd nao. Kha nang ve thSn kinh va tam thin khdng nhiing ngiing phat trien ma con thoai hoa vl mat tii duy, ve mat cam siic.
Di^n phong chi^u v i di^n li^n htfp Diln phdng chieu la dien Uen he tnic ti^p vdi CO thi bang cac diidng dan truyen.
RirtilhinsgicnjODi
Anh 3. Yimggoc cdu tiiu nao
Thang dau tien cua tre, cac dien phdng chilu bat dau cd myelin, cdn cac dien lien hOp thi bat d^u c6 myelin vao thing thii 5 va keo dai tdi nam thiiba(tre3tu6i).
Hin/i 1. M^t ngoai vd ndo
Cdc diip phong chiSu, vi du diip 4, diin 17 Cdc diin Uen hiip, vi dy, di$p 6, diin 8, diin 18,19
141 THAN KINH HOC WET NAM I S(5 23 - QU? I/20T 8 Website: hoithankinhhocvietnam.com.vn
BAO CAO T O N G Q U A N k
Vgn ddng, din truyen cam giac, din truyen gidc quan (xem hinh 1, hinh 2).
Hinh 2. M^t trong vd ndo: cdc dien phong chi^u: dtin 1,4,17 cdc diin liin hc/p: diin 18,19.
Dien lien hdp la nhiJng dien khdng lien hi tnic tiep vdi cd thi ma phai thdng qua cac dien phdng chieu
Cac dien chufc nang d vd nao
Can chd f nguyin tac "3 dien" dl nh4n ra cic dien chiic nang d v6 nao. Vi du, diln va,n dpng (xem hinh l) cd dien van dong cd thi (dien 4), dien tam ly vaji dpng (dien 6) dien van dpng tam than (diln 8). Ddi vdi dien thi giac, (xem hinh 1, hinh 2), cd di|n thi giic cd the (dien 17), dien thi giac tam ly (diln 18) va dien thi giic tam than (ain 19).
Co nhilu so dd chiic nang vd nao, sd dd Broadmann la thdng dting nhat. Sd dd Broadmann c d l l quangtnidngvdi52dien(xemhinh3).
Hinh 3. S(f do Broadmann: A. Mat ngodi. B: Mat trong UuthlbancSu
Thiidng la liu thi ban cau dphiaben trii (80%) va ngiidi do t h u ^ tay phai.
Cdn 20% ngiidi thuan tay trii vdi liu thi ban c^u d phia bin phai.
Cdc trung tdm khong dot xdng
Cac trung tam khdng doi xtlng thiidng d ben ban cau liu thi. Dd la cac tmng tam ngon ngii, trung tam thiic hien va trung tam nhsin thiic.
Tuy nhiln, vai trd cua the trai rat quan trpng va Roger Sperry da nhan thay cac trung tam khdng ddi xilng nay truyen thdng tin qua the trai.
Bdnh gid Uu thibdn cdu
Danh gia qua cac ddng tac hang ngay. Vi du xem "thu^ tay nao ? an cdm thi ngddi dd cSm dua d tay nao?
Thiic tl, khdng cd triidng hpp nao thugn hoin toan d mpt bin.
Co the dinh gia bieu hien cic liu the bin cau qua cac tit: v6 tay, khoanh tay, dap gd.
HOAT DONG TAM LY
Hogt dpng aia cic chiic nang cao cap cua vd nao la ciia toan b^ nao - nhat la vd nao, vimg diidi vd, hoat dpng nay co lien quan mat thilt vdi cac chat dan truyin than kinh thdng qua sii tiidi mau ciia toan nao.
Chiic nang tam ly cua vd nao la cac mat hoat ddng cua tam ly tam than.
Hoat dpng tam ly diia tren 3 qui trinh cd ban:
nhin thilc hogt dpng, tinh cam va hanh dpng.
* Hoat dpng n h ^ thilc, bat dau - tii cam giic, kit qui cua nhiing hiln hidng ben ngoai difdc phan inh vao nao. Tii cim giic tong hdp thanh tri giac, khdng nhiing phan anh khia canh tinh chjit sii vat ma ci toan bp sii vat. Tn giac diidc liiu lai, bao tdn d nao, tich liiy thanh nhiing nhan thiic, va
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^ BAO CAP T 6 N G QUAN
kha nang con ngiidi giii lai tri giac, cam giac bieu Id ra nhan thilc, hieu biet gpi la tri nhd,
Hinh thiic cao cap ciia hogt dpng nhgn thilc la tii duy. Qua trinh tii duy cho kha nang tong hop, phan tich, so sinh, t|p h(?p, khai quit, phan doin, suy luan nhiing hien tiidng phan anh qua tri giac, nhan thilc.
* Qua trinh cam siic, bieu hien thai dp cua con ngiidi doi vdi hiln tiidng, sii v^t xung quanh. Cam xiic cd thi vui, budn, thd P, khoii cam...
* Hanh dpng la thai dp cua con ngiidi ddi vdi ben ngoai. Cd thebieuld bSngdpngtac cd y thiic, bang tii the dang dilu, nit mat, Idi ndi...
* Roi logn ngdn ngd - That ngdn (cdn gpi la Mat ngdnnguf).
Ngdn ngii khdng chi la nhiing tii rilng bilt ma la nhflng cau, nhiing til ngii de diln ta tii duy.
Tii duy = ngdn ngd bin trong- tiingfldosii phdi hop aia toan bd nao (hinh 4).
giai, khdng hilu Idi ndi - ndi khong hilu. Khdng nlu dtfdc hinh anh, ndi khdng dung: tdn thiidng d vung sau hdi khep ranh Sylvius hdi nip cong c6 Mu dpc, tdn thiidng d hdi thil nhit thii diidng tdi hdi khep ranh Sylvius cd Mat cam ngdn Wernicke, Rdi loan Thiic van - thIt dung (Mat Thi^c van)
Cic bilu hi^n nay bao gom nhieu logi:
- Mfit kha nang sap xip, trien khai cic chiicftig trinh hogt dpng van ddng.
- Mat khi nang sd dung cic dd vat, dting cu.
- Mat nhan thilc dinh khu cd the, khdng bilt benh.
- Mat khi nang doc, tinh, sd.
Xem tdm tit Mat Thiic vin qua hinh 5.
MUdnfcvta
Hinh 4. Trung tdm cua cdc hinh thdi rSi lo^n ngon ngit Tdn thiidng thuy trin cd miit kha nang ndi, cdn kha nang hieu Idi ndi... tdn thiidng 6 viing van ddng tay (chan diln 4), cd mat viet, ton thfldng d vung khep ranh Rolando cd Mit van ngdn Bro- ca...
Tdn thfldng thiiy thai dfldng cd rdi loan ve 1^
HinhS-M^tthi^cv^n
Co thi khim phat hien qua cac tit, vi du nghiem phip 3 td giiy, nghilm phap 3 que diem.
Rdi loan nhan thilc - Th^t tri (Miit n h ^ thiic) Cd nhilu logi rdi loan MSt nhin thilc: m^t nhan thflc ve cim giac, mat nhan thilc ve cic giic quan va tdn thfldng d cic khu viic tfldng ilng d vd nao...
Mdt nh4n thUc vicdntffdc
• Mit cam giic nhgn bilt do vat
• Mat cam giic tfl till vj tri.
Mdt nh^n thde vi thi gidc
Tdn thfldng huy hoai giy Mu vd nao, ngflcS blnh thay khdng gian trdng rdng, khdng sing khdng tdi.
Mu tam thin (dien 19): khdng phin biet ddi tfldng, khdng nhgn ra ddi tfldng mac du vin trdng
161 THAN KINH HOC VIE! NAM I S6 2 3 - Q U V 1/2018 Website: hoithankinhhocvietnam.com.vn
BAO CAO T O N G Q U A N k.
thay (thi Itfc tdt). Ngfldi blnh phii sd, nghe mdi bilt ddi tflpng.
Khdng cd khii niem ve khdng gian.
Mdt nh^n thde vi thinh gidc Thilu hieu bilt vl Idi ndi, ve im. nhgc.
Mdt hinh thii rdi logn cam ngdn.
SUY GIAM NHAN THUn; NHE
0 ngfldi cao tudi, til quang 60 - 65 tudi, qui trinh thoii hoa myelin phit trien sfl lao hoa cua h? thin kinh... se din tdi bien doi cic chiic nang thin kinh, tim ly tim than - nhat la sfl suy giam nh^n thilc.
Sfl suy giim nhan thflc la tat ylu ciia qua trinh lao hoi. Sfl suy giim nay cd the li blnh thfldng, c6 thi chuyen thanh benh vcfi nhieu mflc dp khac nhau cung la nhflng tien trien khic nhau.
Suy gidm nhan thflc nhe ve tri nhd Tri nhd la chd diia cua tdn bd phflc hcfp vd nio (Guy Lazorthes, 1984): hdi hii ma, cu nhii hinh, tdn vd nio.
Giim tri nhd - quen cd the d khau ghi nhd, d khau liiu trfl hay d khau hoi flc.
Giam tri nhd cung can dfldc chu y dinh gii so vdi tudi va trinh do hpc van (thap cao), cua ngfldi cao tudi, cua ngfldi blnh.
Cd the ngflcft dd khd khan khi ghi nhd thdng tin mdi, qua dai phit thanh tmyln hinh hogc qua dpc bao.
Nhflng hiln tfldng trin dfldc "ngfldi blnh"
(ngfldi cao tudi) nhin thSy sau mot thdi gian dii.
Sfl khd ghi nhd nay dfldc ngfldi blnh cam thay li do khd tip trung chii jf^xem qua dii, bao.
Cd thi "ngfldi blnh" quin sfl viec - quin sfl vi|c mdi, quin thao tic nghe nghiep, quen ten ngfldi than. Cd ngfldi blnh khdng tai nao gpi tin ngfldi dfldng dflng trflde mat. Hiln tfldng nay
cung dfldc ngfldi blnh "cam thay" sau mdt thdi gian: cd the ban dau thinh thoang thiy khd khan lim mdi nhd dfldc cic tfl ngflhoac tin quen thudc.
Cd thi ngfldi blnh thiy khd khan nhd lai nhiing ky niem quan trong cua bin thin, gia dinh vi xa hpi.
Suy giam n h ^ thiic nhe
Suy giam nhin thflc nhe d ngfldi cao tuoi li cd nhflng rdi loan khic nhfl ngon ngfl, tri giic vi thflc van.
Suy giim nhin thflc nhe cho ta thay cd nhilu tdn thfldng (teo nao, mgch mau) d nhilu khu vflc d vd nio nhit la d vtmg tran, vung thii dfldng, vung bin dfldi thai dfldng.
SASUTTRiTUi
Suy giam nhin thflc nhe la nhdm blnh cd thi phat triln thinh sa siit tri tul do mgch mau, blnh Alzheimer, hogc cung cd the chl la qui trinh lao hoi nio.
Tfl "suy giam nhan thflc" phit trien thanh sa sut tri tul nhanh hay chim la tuy thudc vao tic nhin giy blnh: do tdn thfldng mgch mau, do teo thuy trin, thuy thai dfldng:
Cd th£ rdi lo^n tam ly phit trien tit td tang dain Ngfldi blnh cd hogt ddng giim mat khi nang chii y, giam tri nhd: quen mot each rd ret vi ngfldi than thiy rit rd, ngfldi blnh khong suy xet, hinh tfl(?ng dfldc.
Rdi loan vl tinh cdm, thd O, cd t h i ndi nhilu hay nhdc lai chuyen cu.
C6 thi cd mat thflc vin. Khd hay khong biet sfl dung cic ddng tic quen thupc hang ngay, vi du dpng tic mac quin io...
Cd thi cd rdi loan ngdn ngfl vdi nhieu dang khic nhau tuy theo ton thfldng d vung trin hay viing thai dfldng.
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A BAO CAO TONG QUAN
Cd thi cd rdi loan mit nhin thflc thi giac.
Cic bieu hiln tren ngay cang ting, ngfldi blnh khd dap flng lai cac hogt dpng nghi nghilp va hoat dpng xa hdi
Ngfldi blnh d tinh trang flc che, bi ddng khdng bieu Id tinh cam, phin flng, ngfldi blnh giam hoan toan sfl suy xet ddi xfl.
Cd nhu!ng rdi loan ve trfldng Iflc, ve dinh dfldng, rdi loaned tron.
* Ngfldi benh d trang thii lu lan, mit duih hfldng ve thdi gian va khdng gian, vl quan he bin than va xa hpi... Cd d mflc dp khic nhau vl thit ngdn (mat ngdn ngfl), thit dung (mit thflc van), that tri (mat nhan thflc).
Ttftig thdi ky cd nhflng cdn hoang tfldng, ao giic, khuynh hfldng tan cdng, huhg cam hoae vd cim.
* Sau cung ngfldi benh d tinh trang sa sut nang nl ddng thcri cd nhiftig cdn co giat kilu ddng kinh.
* Q cic trung tim nghiln cflu, ngfldi blnh dfldc kham qua cic nghiem phap Than Idnh tim ly... Thfldng ngfldi benh dflpc khim xet qua thfl nghiem Folstein (cdn gpi li Dinh gia tri nhd thfl nghiem tri tue).
NHIEU C H O N G B E N H CO SA SUT TRi TUE Co tdi 70 logi chilngbenh cd Sa sut tri tue trong dd blnh Alzheimer chiem khoang 55%, benh mach mau nio la 20% vi cic nguyin nhin khac la 25%.
Cin chii y tdi;
- Koi \oQ.n chuyin hod \ dinh dudng.
- Ngg ddc thudc man tinh.
Thfldng la do dung thudc an than, khdng dung chi dinh, keo dai, qui lilu Ifldng
- Nhiim triing man tinh; giang mai, AIDS...
- Viim ndo: Hien nay, viim ndo dngUcfi Wn, viim ndo d tre em deu co mot ty le ddng ke di chvtng ve tdm thdn - Sa sdt tri tue.
- Sa sut trong cdc Binh Thodi hod dNdo, cdn chtiy:
• Benh Alzheimer (xem hinh 6).
• Nhoi miu da 6 (xem hinh 6, hinh 7).
. Hdn hdp Benh Alzheimer va Nhdi miu da o (xem hinh 6, hinh 7).
Hinh 6. 6 teo ndo d mdt ngodi
Hinh 7. 6 tSn thUdng d mat \
Hinh 8. Teo vd t6n ihuangnh6i mdu
CO GANG PHAT HIEN SdM - C H O N G SA SUT TRiTUE
- Phit hiln sdm chflng Sa sut tri tul chinh la nhan ra dfldc "suy giam nhin thflc nhe" (MCI = MUd Cognitive Impairment), suy giam nhan thiiic nhe vl Tri nhd.
- Can dinh gia toan diln vl lim sang ciia suy giam nhan thflc nhe vl tri nhd, can xem thii dg cua ngflcfl blnh doi vdi sfl giam mat tri nhd, ddng thdi nhgn xet cua ngfldi xung quanh ngfldi benh
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BAO CAO T O N G Q U A N h.
(ngfldi trong gia <^nh, xa hpi).
- Cin danh gii ngfldi benh qua cac tet vl Thin kinh tim 1;^, tnidc het la tit Folstem, ddng thdi phai dinh gia tinh trgng ngfldi blnh qua cic xet nghilm cd bin (huylt hpc, sinh hoa.,.), qua hinh anh hoc nao: chup cat lop vi tinh, chup cdng hfldng tfl, chup cat Idp phit xg diln tfl dfldng...
SigsiifchitMjuhlyf.
• r l ;
^^£>t^,;lf^'C£l^.iifatbl£ Ihdng Fin d m gidc
DIEUTRI
Dieu tri Sa siit tri tul trong benh Thodi hoa d nao Blnh Alzheimer, blnh Nhoi mau da 6, benh phdi hdp Alzheimer va Nhdi miu da d la v ^ de nan giii. Nam giai mpt phan vi nhilu quan diem ly thuyet ve cd che tic ddng thudc, mdt phin vi tinh trang ngfldi benh: gia, yeu chiu dflng, da benh ly...
- Can sdm nh^n ra chflng suy giim nhin thflc nhe dl dieu tri kip thdi.
- Thudc cai thien tuan hoan nao. Co nhilu logi, thfldng dung Cavinton, Piracetam, Nootropil...
- Yeu td dinh dfldng thin kinh.
Yeu td dinh dfldng thin kinh c6 the ngan chan
hogc lam chim qua trinh thoai hoa ndron. Cd the dieu hoa sfl tong hdp cic chat trung gian din truyen thin kinh.
Cd the dimg Cerebrolysin cho tilm hogc udng + Ginkgo biloba. Cd tic dung tang tuin hoan nio, lim giam nguy cd huyet khdi, bio vl tl bao than kinh, cai thiln khi nang nhan thflc va tri nhd.
Cd the dung Giloba, hoae Tanakan...
+ Vitamin E: co tic dung lam cham qua trinh thoai hoi mit myelin.
Phuc hoi chiic nang tam ly
Phuc hoi chdc ndng tdm l^ doi hdi s^ tham gia cua nhiiu ngdnh nhiiu ngiidi
"Thay thudc- ngfldi benh-Gia <£nh= Xihpi"
Phdi t4n d^ng nhiiu KET HOP trong phuc hoi chdc ndng tam ly
+ Kit hpp "Thay thudc - ngfldi benh-xa h^i"
(gia dinh, cd quan).
+Ket hdp gifla Y hoc hiln dgi va Y hpc co truyen dan tdc, dilu tri ndi tni vi dieu tri ngoai tni.
+ Ket hc^ dilu tri ngay tai gifldng blnh vdi cd sd phuc hdi chflc nang...
Cdng tdc tdm ly ddi vdi ngUdi hinh ldm ngttdi benh an tdm, tin tudng vd quyit tdm chda binh, tu tdp luyin mgt cdch bin bi, kiin tri, kiin tri trong t4p thd, luyen tri nhd vd iinh tdm.
Cd thi dimg ngay bang Folstein dl tiln hanh
"huin luyin tri nhd" dio ngfldi blnh. Ngflcfl lam tam ly phii kiln tri, binh finh hfldng din ngfldi blnh.
Dgng vien giiip dd ngUifi binh "hoa minh vdo cdngddng" nhUsinh hogt cdc cdu lac bg - cdu lac bg ddnh cho ngUifi cao tudi, cdu Igc bg cif, cdu Igc b^ vdn thg, Cdu lac bg thidifc, khi cdng, dUdng sinh. Yoga...
Kit hap cho ngUifi binh cdn bdng giiia dn udng vd nghi ngdi, nham nang cao sdc khoi todn diin cho ngUdi binh.
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