Ghid practic de utilizare evaluare geriatrica.

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Ministerul Sanatatii

Ordin nr. 1454 din 2010

 

Argumente, eficienţa, cuantificarea datelor evaluării, formarea limbajului medical european şi internaţional

Conf. Univ. Dr. LUIZA SPIRU

Preşedinte al Comisiei Naţionale de Geriatrie şi Gerontologie

Catedra de Geriatrie Gerontologie / U.M.F. ,,Carol Davila” Bucureşti

Şef Clinica Universitară Geriatrie Gerontologie/Spit. Univ. de Urg. Elias

Şef Centrul de Diagnostic şi Tratament al Bolilor de Memorie

Coordonator pt România al European Alzheimer’s Disease Consortium

Evaluarea geriatrică (EG) este o abordare interdisciplinară care vizează estimarea medicală şi psihosocială a pacientului, stabilirea unui diagnostic corect şi identificarea strategiilor adecvate pentru prevenţie, tratament şi reabilitare. Astfel, eforturile şi cheltuielile în domeniul îngrijirii medicale pot fi reduse, iar speranţa de viaţa va creşte.

EG include un istoric natural complex al fiecărui pacient, care include date personale, detalii antropometrice, antecedente heredocolaterale, diagnosticări şi tratamentele anterioare şi date referitoare la condiţiile ambientale de viaţa (fumat, alcool, droguri, stress, mediu toxic, statutul social).

Este un proces multidimensional realizat pentru evaluare:

  • clinică,
  • funcţională,
  • psihico-cognitivă,
  • mentală,
  • paraclinică,
  • imagistică,

a persoanelor în vârstă.

EG cuprinde scale de evaluare specifice grupelor de vârstă, de peste 50 de ani, care facilitează într-un timp eficient obţinerea de informaţii pentru stabilirea unui DIAGNOSTIC CORECT DE VÂRSTÂ, în contextul polipatologiei pacientului.

S-a constatat că numeroase persoane vârstnice suferă de:

– probleme medicale,

– probleme mentale,

– probleme sociale complexe

EG vizează o instruire asupra concluziilor modificărilor medicale şi psihosociale ale persoanelor în vârstă.

EG începe cu identificarea deteriorării clinice şi a factorilor de risc ai acestei deteriorări. Deteriorarea clinică se referă la:

– agravarea unei boli

– înrăutăţirea statuss-ului funcţional

Profesioniştii din sănatate dezvoltă strategii de:

– prevenire,

– tratare,

– reeducare

pentru

– ameliorarea capacităţilor funcţionale ale pacientului,

– păstrarea capacităţilor funcţionale ale pacientului,

– creşterea speranţei de viaţă.

Evaluarea de Geriatrie-Gerontologie

  • ISTORIA NATURALĂ A PACIENTULUI- stabilită împreună cu pacientul şi familia acestuia
  • EVALUAREA GERIATICĂ A PACIENTULUI

Realizarea unui istoric corect, elaborat, cu ajutorul pacientului şi aparţinatorului este cheia unui diagnostic corect şi a prioritizării reale a diagnosticului final, în cadrul polipatologiei pacientului.

Istoricul natural este urmat de aplicarea unui set de scale de evaluare specific pentru fiecare grupă de vârstă (începând de la 50 de ani):

  • Mini-evaluare a stării mentale (MMSE), Folstein şi Groupe de Recherche sur les Évaluations Cognitives, Folstein-Greco (vezi ghid scale de evaluare şi anexa 1)
  • Testul orologiului (CDT), H. Brodaty: care reflectă funcţiile cortexului frontal şi temporo-parietal
  • Scorul activităţilor cotidiene (ADL) şi Scorul activităţilor cotidiene ce necesită folosirea instrumentelor (IADL), ambele în variantă prescurtată: pentru evaluarea independenţei/dependenţei pacientului;
  • Scala Depresiei Geriatrice Yesavage (GDS) forma prescurtată pentru detectarea simptomelor depresive;
  • Evaluarea echilibrului static şi dinamic (Tinetti): pentru diagnosticarea bolilor neurodegenerative;
  • Mini-evaluarea nutritională (MNA), Guigoz Y, Vellas B and PJ Garry: pentru evaluarea statutului nutriţional al pacientului,
  • Scala Bedsore Norton pentru pacienţii cu patologie severă
  • Analize paraclinice
  • Explorări funcţionale
  • Investigaţii imagistice
  • Teste pentru diagnostic diferenţial
  • Scale de evaluare specifică pentru pacienţii cu patologie neurodegenerativă
  • Profilul psihologic
  • Evaluarea socio-economică a pacientului şi a familiei acestuia.

Referinţe:

  1. Brodaty H, Moore CM – The Clock Drawing Test for dementia of the Alzheimer type: a comparison of three scoring methods in a memory disorders clinic. International Journal of Geriatric Psychiatry 12: 619 -27,1997.
  2. Brodaty H, Moore CM. The Clock Drawing Test for dementia of the Alzheimer’s type: A comparison of three scoring methods in a memory disorders clinic. Int ] Geriatr Psychiatry. 1997; 12:619-627.
  3. Burke WJ, Houston MJ, Boust SJ et al (1989) Use of the Geriatric Depression in dementia of the Alzheimer type. Journal of the American Geriatrics Society 37 : 856-60
  4. Cockrell JR and Folstein MF (1988) Mini Mental State Examination (MMSE), Psychopharmacology, 24: 689-692.
  5. Crum RM, Anthony JC, Bassett SS and Folstein MF (1993) Population-based norms for the mini-mental state examination by age and educational level, JAMA, 18: 2386-2391.
  6. Cummings JE, Mega M, Gray K, et al. The Neuro-psychiatric Inventory: Comprehensive assessment of psychopathology in dementia. Neurology. 1994;44;2308-2314.
  7. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J (1994) The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 44: 2308-14
  8. Derouesné C. & Coll du groupe GRECO, Le Mini-Mental State Examination (MMSE): un outil pratique pour l’évaluation de l’état cognitif des patients par le clinicien. La Presse Médicale, Masson, Paris, 1999, 28, p. 1141-1148
  9. Folstein MF, Folstein SE, McHugh PR. „Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psycbiatr Res. 1975;12: 189-198.
  1. Folstein MF, Folstein, SE and McHugh PR (1975) Mini-Mental State: A practical method for grading the state of patients for the clinician, Journal of Psychiatric Research, 12: 189-198.
  2. Frisoni G., Frölich L., Johannsen P., Johansson G., Kehoe P., Lovestone S., Olde-Rikkert M., Reynish E., Visser P J., De Deyn P.P., Salmon E., Vandenberghe R., Traykov L.; Waldemar G.; Erkinjuntti T., Soininen H.; Camus V., Ceccaldi M., Dubois B., Orgogozo J.M., Pasquier F., Rigaud A.-S., Robert P., Touchon J., Vellas B.; Froëlich L., Heuser I., Kornhuber J., Kurz A., Stiens G., Costa-Tsolaki M.; Italy: Bernabei R., Frisoni G., Nobili F., Mecocci P., Rodriguez; Portugal G.,: Mendonca A., Spiru L.; Blesa R., Boada-Rovira M., Cruz A., Gómez-Isla T., Martinez-Lage P., Molinuevo J.L., Ribera Casado J.M.,, Salvà A., Sanchez-Lopez F.; SwedenMinthon: L., Skoog I., Winblad B., Michel J.-P., Hock C., Spiegel R., Olde Rikkert M., Scheltens P., Verhey F.,Barcikowska M., Sobow T.; Bullock R., Burns A., Jones R.W., Kehoe P., Lovestone S., Rossor M.,Sinclair A., Smith D., D. Wilkinson, Editorial EADC (EUROPEAN ALZHEIMER DISEASE CONSORTIUM) Recommendations for future Alzheimer Disease Research in Europe; The Journal of Nutrition, Health & Aging; ISSN: 1279-7707, Vol 12, Nr 10, 2008
  1. Garry P., Vellas B., : Practical and validated use of the Mini Nutritional Assessment in geriatric evaluation. Nutrition in clinical Care Vol 2 N°3 1999 : 146-154
  2. Gottfries CG, Brane G, Steen G (1982). A new rating scale for dementia syndromes. Gerontology 28: 20- 31
  3. Grasel E et al (1990) What contribution can the Hachinski ischaemic scale make to the differencial diagnosis between multi-infarct dementia and primary degenerative dementia?, Arch Gerontol Geriatr 11:63-75
  1. Groupe de Recherche sur les Evaluations Cognitives (GRECO), M.M.S.E. – Mini Mental State Examination. Version française soumise à consensus, Ed.Esaï & Pfizer 02/1998
  1. Hachinski C (1983) Multifocal dementia. Neurologic Clinics 1: 27-36
  2. Hackinski VC, Iliff LD, Zilka E et al (1975), Cerebral Blood flow in dementia. Archives of Neurology 32:632-7
  1. Katona C (1994), Depression in old age. Chichester : John Wiley & Sons.
  2. Lawton MP, Brody EM, Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist 9: 179-89, 1969.
  1. Lawton MP, Brody EM. Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist. 1969 ;9:179-186.
  2. National Institute of Mental Health. CGI: Clinical Global Impressions. In: Guy W, Bonato RR, eds. Manual for the ECDEU Assessment Battery.2. Rev ed. Chevy Chase, Md: National Institute of Mental Health; 1970:12-1-12-6.
  3. Norberg J., Graff C., Almkvist O., Ewers M. E., Frisoni G. B., Frölich L., Hampel H., Jones R., Kehoe P., Lenoir H., Minthon L., Nobili F., Olde Rikkert M., Rigaud A.-S., Scheltens Ph., Soininen H., Spiru L., Tsolaki M., Wahlund L.-O., Vellas B., Wilcock G., Verhey F., Visser P. J.; Regional effects of APOE ε4 in mild cognitive impairment and subjective cognitive impairment: Results from the DESCRIPA study, Neuroepidemiology, ISSN: 0251-5350, 2009
  1. Panisset M, Roudier M, Saxton J et al (1994). Severe Impairment Baterry: a neuropsychological battery for severely impaired patients. Archives of Neurology 51: 41-5
  1. Petersen,R.C., Smith,G.E., Waring,S.C., Ivnik,R.J., Tangalos,E.G., and Kokmen,E. (1999). Mild cognitive impairment: clinical characterisation and outcome. Archives of Neurology 56, 303-308.
  1. Ramakers IHGB, Visser PJ, Aalten P, Boada M., Jones R., Frisoni GB, Spiru L, Nobili F, Soininen H, Touchon J, Portet F, Olde Rikkert M, Wilcock G, Hampel H, Scheltens Ph, Frölich L & Verhey FRJ; The prevalence and severity of neuropsychiatric symptoms in subtypes of Mild Cognitive Impairment: The DESCRIPA study; IPA Junior Research Awards in Psychogeriatrics, ISSN 1041- 6102, 2009
  2. Reynish E., Cortes F., Andrieu S., Cantet C., Olde Rikkert M., Melis R., Froelich L., Frisoni G.B., Jönsson L., Visser P.J., Ousset P.J., Vellas B., Jones L R.W., Burns A., Bullock R., Malick A., Salmon E., Waldemar G., Dartigues J.F., Pasquier F., Touchon J., Robert Ph., Rigaud A.S., Camus V., Stiens G., Frölich L., Costa-Tsolaki M., Frisoni G., Rodriguez G., Cherubini A., Spiru L., Boada M., Salva A., Agüera-Morales E., Ribera-Casado J.M., Lage P.M., Winblad B./ Eriksdotter Jönhagen M., Michel J.P., Scheltens P., Olde-Rikkert M., The ICTUS Study: A Prospective Longitudinal Observational Study of 1,380 AD Patients in Europe; Study Design and Baseline Characteristics of the Cohort; Neuroepidemiology, ISSN: 0251-5350, 2007;29:29-38; Sept. 24, 2007
  1. Shah A, Herbert R, Lewis S et al (1997). Screening for depression among acutely ill geriatric inpatients with a short geriatric depression scale. Age and Ageing 26 : 217-21
  1. Shiekh J, Yesavage J (1986). Geriatric Depression Scale ; recent findings and development of a short version. In Brink T, ed. Clinical gerontology : a guide to assessment and intervention. New York : Howarth Press
  1. Shulman K, Shedletsky R, Silver I (1986), The challenge of time. Clock drawing and cognitive function in the elderly. Internation al Journal of Geriatric Psychiatry 1 : 135-40
  1. Spiru L, Cristescu F, Prevalence of Co-Morbidities in Mild Cognitive Impairment (MCI), Brain Aging International Journal, Vol. 4, No 1 2004;
  2. Spiru L, Cristescu F, Prevalenta comorbiditatilor la pacientii cu deficit cognitiv lejer (MCI), Brain Aging International Journal – editie in limba romana, Vol. 1, Nr. 2, 2003
  3. Spiru L, Romosan I. Geriatrie, Vol. I, Editura Solness, Timisoara, 2002
  4. Spiru L, Romosan I. Geriatrie, Vol. II, Editura Solness, Timisoara, 2002
  5. Spiru L, Vellas B, Ousset PJ, Scorul activitatilor vietii cotidiene, Brain Aging International Journal – editie in limba romana, Vol. 1, Nr. 2, 2003
  6. Spiru L, Vellas B, Ousset PJ, Winblad B, Testul MMSE (Mini Mental State Examination) si testul orologiului, Brain Aging International Journal – editie in limba romana, Vol. 1, Nr. 1, 2003
  7. Spiru L, Vellas B, Ousset PJ,, Scorul IADL al activitatilor curente, Brain Aging International Journal – editie in limba romana, Vol. 2, Nr.1, 2004
  8. Spiru L, Vellas B, Ousset PJ. Caiet de observatie pentru pacientii cu dementa tip Alzheimer , Editia I, Editura Universitara ,,Carol Davila”, Bucuresti, 2000.
  9. Spiru L, Vellas B, Ousset PJ. Caiet de observatie pentru pacientii cu dementa tip Alzheimer, Editia II, Editura Universitara ,,Carol Davila”, Bucuresti, 2000.
  10. Spiru L, Vellas B, Ousset PJ. Teste clinice pentru diagnosticul dementei de tip Alzheimer, Editura Universitara ,,Carol Davila”, Bucuresti, 2001
  11. Spiru L., Vellas B., Ousset P.J., Effects of Hospitalization on Cognitive Function, Activities of Daily Living Capacity and Behavior in Alzheimer’s Disease Patients: a Longitudinal Study, Brain Aging International Journal, ISSN 1582-8352; Vol. 1, nr. 1 / 2002
  12. Spiru L., Prevalence of co-morbidities in mild cognitive impairment (MCI) patients – a Romanian descriptive study, Neurobiology of Aging, ISSN: 0197- 4580, Vol: 25, Issue 2, Pg: S313-S313, Data: 2004-2007
  13. Spiru L., A Romanian DESCRIPA project presentation; Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, ISSN: 1552-5260, Vol: 2, Issue: 3, Pages: S285-S285, Data: 7-2006
  14. Spiru L., A Romanian EC DESCRIPA project presentation, Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, ISSN: 1552-5260, Vol: 3, Issue: 3, Pg: S155-S156, Data: 2007-7
  15. Spiru L.; Mild cognitive impairment – MCI: Should it be treated or not? Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, ISSN: 1552-5260, Vol: 4, Issue: 4, Pg: T494-T494, Data: 2008-7
  16. Spiru L., Turcu I., Conversion of Mild cognitive impairment (MCI) to Alzheimer Disease (AD). Risk factors. International Conference on Alzheimer’s Disease, Viena, 11.07 – 16.07.2009; Alzheimer’s & Dementia, ISSN 1552-5260, iulie 2009
  17. Tangalos EG, Smith GE, Ivnik RJ, et al. The Mini-Mental State Examination in general medical practice: Clinical utility and acceptance. Mayo Clin Proc. 1996; 71:829-837.
  18. Tsolaki M., Papaliagkas V., Jones R., Touchon J., Spiru L., Visser P. J., Verhey F., DESCRIPA Study Group; Medication in patients with mild cognitive impairment in Europe: The development of screening guidelines and clinical criteria of predementia Alzheimer’s disease (DESCRIPA) study; Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, ISSN: 1552-5260, Vol: 4, Issue: 4, T683-T684; 2008
  19. Vellas B. , Guigoz Y., Garry P., Nourhashémi F., Bennaoum D., Lauque S., Albarède J L., : The mini nutritional assessment (MNA) and is use in grading the nutritional state of elderly patients. Nutrition 99, 15:116-122
  20. Vellas B., Standardized geriatric evaluation. An efficient method for the prevention of dependency; Soins. Gérontologie 1996;(2):6.
  21. Visser PJ, Verhey FR, Boada M, Bullock R, De Deyn PP, Frisoni GB, Frolich L, Hampel H, Jolles J, Jones R, Minthon L, Nobili F, Olde Rikkert M, Ousset PJ, Rigaud AS, Scheltens P, Soininen H, Spiru L, Touchon J, Tsolaki M, Vellas B, Wahlund LO, Wilcock G, Winblad Development of screening guidelines and clinical criteria for predementia Alzheimer’s disease. The DESCRIPA Study, B. Neuroepidemiology, ISSN: 0251-5350; 30(4):254-65; 2008
  22. Visser P. J., Verhey F., Knol D., Scheltens P., Wahlund L., Freund-Levi Y., Tsolaki M., Minthon L., Wallin Å., Hampel H., Buerger K., Pirttila T., Soininen H., Olde Rikkert M., Verbeek M., Spiru L., Blennow K., Prevalence and prognostic value of cerebrospinal fluid markers of Alzheimer pathology in subjects with subjective cognitive impairment and mild cognitive impairment. The DESCRIPA study. The Lancet Neurology, ISSN: 1474-4422, 2009
  23. Zarit SH, Orr NK, Zarit JM. The hidden victims of Alzheimer’s disease; families under stress. New York: New York University Press; 1985
  24. Zarit SH, Reever KE, Bach-Peterson J. Relatives of impaired elderly: correlates of feeling of burden. Gerontologist 1980; 20:649-55.
  25. Visser PJ, Verhey F, Knol DL, L. Spiru et al., Prevalence and prognostic value of CSF markers of Alzheimer’s disease pathology in patients with subjective cognitive impairment and mild cognitive impairment in the DESCRIPA study: a prospective, case–control study. Lancet Neurol 2009; published online June 11. DOI:10.1016/S1474-4422(09)70139-5.
  26. J. Norberg, C. Graff, O. Almkvist, M. E. Ewers, G. B. Frisoni, L. Frölich, H. Hampel, R. Jones, P. Kehoe,
  27. Lenoir, L. Minthon, F. Nobili, M. Olde Rikkert, A.-S. Rigaud, Ph. Scheltens, H. Soininen, L. Spiru, M.Tsolaki, L.-O. Wahlund, B. Vellas, G. Wilcock, F. Verhey, P. J. Visser, Regional effects of APOE ε4 in mild cognitive impairment and subjective cognitive impairment: Results from the DESCRIPA study
  1. A pilot, comparative epigenomic and metabolomic study in healthy elderly, adult and young people, Cucu N., Anton G., Radu LG, Turcu I., Spiru L, in: Collection of Selected Free Papers from the 9th International Conference on Alzheimer’s and Parkinson’s Disease AD/PD, Prague, Czech Republic, March 11-15,2009, Editors: Abraham Fisher and Israel Hanin, Medimond International, January 2010, pp.83-89
  1. Gender aspects in Mild cognitive Impairment (MCI) to Alzheimer’s Disease (AD) conversion. A Romanian epidemiological study, Spiru L., Ioancio I., Nuta C., Turcu I., in: Collection of Selected Free Papers from the 9th International Conference on Alzheimer’s and Parkinson’s Disease AD/PD, January 2010, pp.59-65
  1. Arguments for the reconsideration of procaine as a potent therapeutic molecule in AD/PD, Turcu I., Spiru L., in: Collection of Selected Free Papers from the 9th International Conference on Alzheimer’s and Parkinson’s Disease AD/PD, Prague, Czech Republic, March 11-15, 2009, Editors: Abraham Fisher and Israel Hanin, Medimond International, January 2010, pp.127-135
  1. A pilot, comparative epigenomic and metabolomic study in healthy elderly, adult and young people, Cucu N., Anton G., Radu LG, Turcu I., Spiru L, in: Collection of Selected Free Papers from the 9th International Conference on Alzheimer’s and Parkinson’s Disease AD/PD, Prague, Czech Republic, March 11-15,2009, Editors: Abraham Fisher and Israel Hanin, Medimond International, January 2010, pp.83-89
  1. Gender aspects in Mild cognitive Impairment (MCI) to Alzheimer’s Disease (AD) conversion. A Romanian epidemiological study, Spiru L., Ioancio I., Nuta C., Turcu I., in: Collection of Selected Free Papers from the 9th International Conference on Alzheimer’s and Parkinson’s Disease AD/PD, January 2010, pp.59-65
  2. Arguments for the reconsideration of procaine as a potent therapeutic molecule in AD/PD, Turcu I., Spiru L., in: Collection of Selected Free Papers from the 9th International Conference on Alzheimer’s and Parkinson’s Disease AD/PD, Prague, Czech Republic, March 11-15, 2009, Editors: Abraham Fisher and Israel Hanin, Medimond International, January 2010, pp.127-135
  3. Visser PJ, Verhey F, Knol DL, L. Spiru et al., Prevalence and prognostic value of CSF markers of Alzheimer’s disease pathology in patients with subjective cognitive impairment and mild cognitive impairment in the DESCRIPA study: a prospective, case–control study. Lancet Neurol 2009; published online June 11. DOI:10.1016/S1474-4422(09)70139-5.
  1. J. Norberg, C. Graff, O. Almkvist, M. E. Ewers, G. B. Frisoni, L. Frölich, H. Hampel, R. Jones, P. Kehoe, H. Lenoir, L. Minthon, F. Nobili, M. Olde Rikkert, A.-S. Rigaud, Ph. Scheltens, H. Soininen, L. Spiru, M. Tsolaki, L.-O. Wahlund, B. Vellas, G. Wilcock, F. Verhey, P. J. Visser, Regional effects of APOE ε4 in mild cognitive impairment and subjective cognitive impairment: Results from the DESCRIPA study

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