S demenc\u00ed se \u017e\u00e1dn\u00fd \u010dlov\u011bk nenarod\u00ed, ale a\u017e p\u011btina senior\u016f mezi 75 a 84 lety v\u011bku s n\u00ed um\u00edr\u00e1. P\u0159\u00ed\u010dinou je zhruba v 60\u00a0% p\u0159\u00edpad\u016f ob\u00e1van\u00e1 Alzheimerova choroba.<\/p>\n
Co je OK a co u\u017e ne<\/p>\n
Ka\u017ed\u00fd ob\u010das zapomene telefonn\u00ed \u010d\u00edslo nebo jm\u00e9no a vzpomene si a\u017e pozd\u011bji. Lid\u00e9 s demenc\u00ed v\u0161ak zapom\u00ednaj\u00ed st\u00e1le, ani\u017e by si pozd\u011bji vzpomn\u011bli. P\u0159iprav\u00ed j\u00eddlo, ale „zapomenou“ ho sn\u00edst, dokonce i \u017ee ho v\u016fbec ud\u011blali. Zat\u00edmco „norm\u00e1ln\u00ed“ \u010dlov\u011bk ob\u010das hled\u00e1 spr\u00e1vn\u00e9 slovo, \u010dlov\u011bk s demenc\u00ed si nevybav\u00ed ani jednoduch\u00e1, z\u00e1kladn\u00ed slova nebo je nahrazuje nespr\u00e1vn\u00fdmi a jeho v\u011bty pak ned\u00e1vaj\u00ed smysl.<\/p>\n
Rozt\u011bkan\u00ed a zavalen\u00ed spoustou rozmanit\u00fdch \u00fakol\u016f a povinnost\u00ed n\u011bkdy ztrat\u00edme ze z\u0159etele, kter\u00fd je den nebo kam jdeme \u010di jedeme, a mus\u00edme se upamatovat \u2013 ale v\u017edy jsme \u00fasp\u011b\u0161n\u00ed, na rozd\u00edl od lid\u00ed s demenc\u00ed, kte\u0159\u00ed se na spr\u00e1vn\u00e9 datum nerozpomenou nebo z\u016fstanou bezradn\u011b st\u00e1t i na dob\u0159e zn\u00e1m\u00e9m m\u00edst\u011b a netref\u00ed dom\u016f. Stalo se v\u00e1m, \u017ee jste br\u00fdle \u010di mobil roztr\u017eit\u011b odlo\u017eili do \u0161pajzu, a d\u00e1v\u00e1te tuto historku k lep\u0161\u00edmu u\u017e l\u00e9ta? Lid\u00e9 s demenc\u00ed by takov\u00e9 p\u0159\u00edhody mohli vypr\u00e1v\u011bt po\u0159\u00e1d, kdyby si je pamatovali, nebo\u0165 \u017eehli\u010dku do ledni\u010dky, kl\u00ed\u010de do trouby nebo hodinky do cuk\u0159enky ukl\u00e1daj\u00ed \u010dasto.<\/p>\n
B\u00fdv\u00e1te n\u011bkdy mrzut\u00ed, apati\u010dt\u00ed \u010di naopak podr\u00e1\u017ed\u011bn\u00ed?<\/p>\n
To je b\u011b\u017en\u00e9, lid\u00e9 s demenc\u00ed v\u0161ak mohou propadnout depresi nebo naprost\u00e9 pasivit\u011b, tak\u00e9 jim prudce kol\u00eds\u00e1 n\u00e1lada a trvale se m\u011bn\u00ed jejich osobnost \u2013 st\u00e1vaj\u00ed se ustra\u0161en\u00fdmi, zmaten\u00fdmi, podez\u00edrav\u00fdmi.<\/p>\n
Probl\u00e9my s pam\u011bt\u00ed spolu s naru\u0161en\u00edm \u00fasudku a \u010dasoprostorov\u00e9 orientace, \u0159e\u010di a ostatn\u00edch tzv. kognitivn\u00edch schopnost\u00ed (pozornosti, abstraktn\u00edho my\u0161len\u00ed a rozpozn\u00e1vac\u00edch funkc\u00ed) pat\u0159\u00ed k prvn\u00edm projev\u016fm demence.<\/p>\n
M\u00e1m ji, nebo nem\u00e1m?<\/p>\n
Demence nikdy nen\u00ed vrozen\u00e1, m\u016f\u017ee toti\u017e vzniknout a\u017e po ukon\u010den\u00ed rozvoje kognitivn\u00edch funkc\u00ed, tj. od druh\u00e9ho roku \u017eivota. U lid\u00ed do 65 let je vz\u00e1cn\u00e1 a v\u011bt\u0161inou m\u00e1 sekund\u00e1rn\u00ed charakter, to znamen\u00e1, \u017ee k n\u00ed doch\u00e1z\u00ed v d\u016fsledku jin\u00e9ho onemocn\u011bn\u00ed. Mezi devades\u00e1tilet\u00fdmi j\u00ed v\u0161ak trp\u00ed skoro ka\u017ed\u00fd druh\u00fd \u010dlov\u011bk. Diagn\u00f3zu s jistotou ur\u010d\u00ed pouze l\u00e9ka\u0159. Zapomn\u011btlivost je p\u0159irozenou vlastnost\u00ed lidsk\u00e9 psychiky, a to ve kter\u00e9mkoli v\u011bku, a odli\u0161it ji od symptom\u016f po\u010d\u00ednaj\u00edc\u00ed demence nelze bez speci\u00e1ln\u00edho vy\u0161et\u0159en\u00ed pam\u011bti a intelektov\u00fdch funkc\u00ed.<\/p>\n
P\u0159i zaznamen\u00e1n\u00ed varovn\u00fdch sign\u00e1l\u016f by m\u011bl pacient nejprve zam\u00ed\u0159it do ordinace praktick\u00e9ho l\u00e9ka\u0159e, kter\u00fd ud\u011bl\u00e1 z\u00e1kladn\u00ed testy a podle v\u00fdsledk\u016f rozhodne o doporu\u010den\u00ed k n\u00e1v\u0161t\u011bv\u011b specialisty (neurolog, geriatr \u010di psychiatr), jen\u017e provede komplexn\u011bj\u0161\u00ed vy\u0161et\u0159en\u00ed.<\/p>\n
K diagn\u00f3ze l\u00e9ka\u0159 pot\u0159ebuje zn\u00e1t rodinnou a osobn\u00ed anamn\u00e9zu (tu zjist\u00ed rozhovorem s pacientem), podrobn\u00e9 vyhodnocen\u00ed zm\u011bn kognitivn\u00edch funkc\u00ed, pam\u011bti a chov\u00e1n\u00ed pacienta b\u011bhem posledn\u00edch m\u011bs\u00edc\u016f \u010di let (vypt\u00e1 se hlavn\u011b na poruchy pam\u011bti, my\u0161len\u00ed a orientace v \u010dase a prostoru a na zvl\u00e1d\u00e1n\u00ed denn\u00edch aktivit, na p\u0159\u00edpadn\u00e9 zm\u011bny osobnosti a chov\u00e1n\u00ed). Pot\u0159ebn\u00e9 je vy\u0161et\u0159en\u00ed kognitivn\u00edch funkc\u00ed pomoc\u00ed souboru test\u016f a klinick\u00e9 vy\u0161et\u0159en\u00ed dopln\u011bn\u00e9 laboratorn\u00edmi testy.<\/p>\n
V diagnostice demence se pou\u017e\u00edvaj\u00ed nap\u0159\u00edklad tyto specifick\u00e9 testy:<\/strong><\/p>\n – Pam\u011b\u0165ov\u00fd test u\u010den\u00ed: Pacientovi se p\u0159e\u010dte 15 jednoduch\u00fdch zn\u00e1m\u00fdch slov, kter\u00e1 si m\u00e1 pot\u00e9 vybavit.<\/p>\n – Test verb\u00e1ln\u00ed fluence (plynulost my\u0161len\u00ed, formulace a \u0159e\u010di, pohotovost, n\u00e1paditost): Je pacient schopen vybavit si v\u011bt\u0161\u00ed mno\u017estv\u00ed slov nap\u0159\u00edklad za\u010d\u00ednaj\u00edc\u00edch ur\u010dit\u00fdm p\u00edsmenem?<\/p>\n * Testy orientace v \u010dase a prostoru: Kolik\u00e1t\u00e9ho je dnes, kter\u00fd je m\u011bs\u00edc, rok, ro\u010dn\u00ed obdob\u00ed, ve kter\u00e9m jsme st\u00e1t\u011b, m\u011bst\u011b?<\/p>\n – Test hodin: Pacient m\u00e1 nakreslit cifern\u00edk hodin se v\u0161emi \u010d\u00edsly a nastavit ru\u010di\u010dky na ur\u010dit\u00fd \u010das.<\/p>\n – T\u0159\u00edstup\u0148ov\u00fd p\u0159\u00edkaz: Zvl\u00e1dne pacient uchopit pap\u00edr do prav\u00e9 ruky, p\u0159elo\u017eit jej na polovinu a polo\u017eit na zem?<\/p>\n – Sedmi\u010dkov\u00fd subtest: Pacient od 100 ode\u010d\u00edt\u00e1 7, od v\u00fdsledku op\u011bt 7 atd., celkem 5x.<\/p>\n 10 sign\u00e1l\u016f ohro\u017een\u00ed<\/em><\/strong><\/p>\n 1. Zapom\u00edn\u00e1n\u00ed komplikuj\u00edc\u00ed ka\u017edodenn\u00ed \u017eivot: Nemocn\u00fd demenc\u00ed si t\u0159eba nevzpomene, jestli u\u017e jedl, zda si \u010distil zuby nebo u\u017eil-li l\u00e9k na vysok\u00fd krevn\u00ed tlak. Nepamatuje si zejm\u00e9na v\u011bci, kter\u00e9 se staly ned\u00e1vno, sp\u00ed\u0161e se rozpomene na ud\u00e1losti z d\u00e1vn\u00e9 minulosti.<\/p>\n 2. Ztr\u00e1ta pam\u011bti postihuj\u00edc\u00ed profesion\u00e1ln\u00ed zru\u010dnost: Posti\u017een\u00fd si nevybav\u00ed \u00fakony, kter\u00e9 suver\u00e9nn\u011b d\u011blal cel\u00fd \u017eivot, nap\u0159\u00edklad „zapomene“ telefonovat nebo platit bankovn\u00ed kartou.<\/p>\n 3. Porucha orientace v \u010dase a prostoru, bloud\u011bn\u00ed na dob\u0159e zn\u00e1m\u00fdch m\u00edstech.<\/p>\n 4. Pot\u00ed\u017ee s \u0159e\u010d\u00ed a formulov\u00e1n\u00edm v\u011bt, zapom\u00edn\u00e1n\u00ed i b\u011b\u017en\u00fdch, jednoduch\u00fdch slov a jejich nahrazov\u00e1n\u00ed nespr\u00e1vn\u00fdmi, opisy („to, jak z toho te\u010de voda“) nebo slovn\u00ed „vatou“ \u2013 vsuvkami bez v\u00fdznamu \u010di z\u00e1jmeny „to“, „ono“\u2026 Verb\u00e1ln\u00ed projev b\u00fdv\u00e1 stroh\u00fd, nen\u00ed plynul\u00fd, ned\u00e1v\u00e1 smysl.<\/p>\n 5. Probl\u00e9my s abstraktn\u00edm my\u0161len\u00edm: Obt\u00ed\u017ee pochopit slo\u017eit\u011bj\u0161\u00ed instrukce (nap\u0159. jak vyplnit po\u0161tovn\u00ed pouk\u00e1zku) nebo d\u011blat \u00fakony vy\u017eaduj\u00edc\u00ed p\u0159esn\u00fd sled krok\u016f.<\/p>\n 6. „Zpomalen\u00e9“ my\u0161len\u00ed, sn\u00ed\u017een\u00ed intelektov\u00e9ho v\u00fdkonu: \u010clov\u011bk \u0161patn\u011b ch\u00e1pe, opakuje ot\u00e1zky, nen\u00ed schopen uv\u00e9st v\u011bci do souvislost\u00ed.<\/p>\n 7. Zhor\u0161en\u00ed \u00fasudku, neschopnost spr\u00e1vn\u011b vyhodnotit situaci: Posti\u017een\u00fd demenc\u00ed nap\u0159\u00edklad nepochop\u00ed, \u017ee m\u00e1 hore\u010dku, a m\u011bl by si tedy uva\u0159it \u010daj, u\u017e\u00edt l\u00e9k, j\u00edt k l\u00e9ka\u0159i, m\u016f\u017ee se nep\u0159im\u011b\u0159en\u011b obl\u00e9knout (v l\u00e9t\u011b ko\u017eich apod.). 8. Ukl\u00e1d\u00e1n\u00ed v\u011bc\u00ed na nesmysln\u00e1 m\u00edsta a neschopnost je potom naj\u00edt.<\/p>\n 9. Ztr\u00e1ta z\u00e1jmu o okoln\u00ed sv\u011bt, absence iniciativy, pot\u0159eba pob\u00eddky ke ka\u017ed\u00e9 \u010dinnosti.<\/p>\n 10. Zm\u011bny chov\u00e1n\u00ed a osobnosti: Posti\u017een\u00e9ho nebav\u00ed d\u0159\u00edve obl\u00edben\u00e9 \u010dinnosti, m\u016f\u017ee b\u00fdt agresivn\u00ed, sobeck\u00fd, nevrl\u00fd, ustra\u0161en\u00fd, zmaten\u00fd. Toto chov\u00e1n\u00ed si neuv\u011bdomuje a odm\u00edt\u00e1 p\u0159ipustit, \u017ee by mohl b\u00fdt nemocn\u00fd.<\/p>\n Odli\u0161it \u201ap\u0159irozen\u00e9\u2018 zapom\u00edn\u00e1n\u00ed od projev\u016f po\u010d\u00ednaj\u00edc\u00ed demence b\u00fdv\u00e1 obt\u00ed\u017en\u00e9.<\/strong> V \u010d\u00e1sti spole\u010dnosti je roz\u0161\u00ed\u0159ena velk\u00e1 tolerance k zapom\u00edn\u00e1n\u00ed a poruch\u00e1m pam\u011bti u osob vy\u0161\u0161\u00edho v\u011bku. P\u0159\u00edbuzn\u00ed a p\u0159\u00e1tel\u00e9 \u0159\u00edkaj\u00ed \u201ano jo, je trochu sklerotick\u00e1\u2018 nebo \u201aob\u010das zapom\u00edn\u00e1, ale tak n\u011bjak p\u0159im\u011b\u0159en\u011b k v\u011bku\u2018, a pacienti se proto \u010dasto dost\u00e1vaj\u00ed k l\u00e9ka\u0159i a\u017e ve chv\u00edli, kdy vinou demence t\u0159eba odejdou z domova a zabloud\u00ed nebo ztrat\u00ed schopnost zvl\u00e1dat b\u011b\u017en\u00e9 denn\u00ed aktivity.\u00a0Nad\u011bje na zlep\u0161en\u00ed \u010di stabilizaci stavu je pak ji\u017e mal\u00e1.<\/p>\n Prvn\u00ed projevy demence lze sn\u00e1ze zaregistrovat u lid\u00ed aktivn\u00edch a spole\u010densk\u00fdch, s mnoha z\u00e1jmy a kontakty, kte\u0159\u00ed do vysok\u00e9ho v\u011bku zvl\u00e1daj\u00ed n\u00e1ro\u010dn\u00e9 kon\u00ed\u010dky, \u0159\u00edd\u00ed auto, pou\u017e\u00edvaj\u00ed po\u010d\u00edta\u010d, prov\u00e1d\u011bj\u00ed bankovn\u00ed operace, samostatn\u011b jednaj\u00ed na \u00fa\u0159adech atd.\u00a0Pot\u00ed\u017ee s pam\u011bt\u00ed, \u0159e\u010d\u00ed, pozornost\u00ed, selh\u00e1v\u00e1n\u00ed v dosavadn\u00edch aktivit\u00e1ch, ztr\u00e1ta z\u00e1jm\u016f, postupn\u00e9 opou\u0161t\u011bn\u00ed z\u00e1lib, stereotypn\u00ed chov\u00e1n\u00ed a podobn\u011b jsou u nich mnohem z\u0159eteln\u011bj\u0161\u00ed a okol\u00ed si jich v\u0161imne sp\u00ed\u0161e ne\u017e u lid\u00ed, kte\u0159\u00ed \u017eili cel\u00fd \u017eivot jednotv\u00e1rn\u011b, na jednom m\u00edst\u011b, nikdy nevykon\u00e1vali intelektov\u011b n\u00e1ro\u010dn\u011bj\u0161\u00ed pr\u00e1ci a n\u00e1roky na jejich denn\u00ed aktivity a du\u0161evn\u00ed v\u00fdkon jsou mal\u00e9.<\/p>\n klinick\u00e9 vy\u0161et\u0159en\u00ed dopln\u011bn\u00e9 laboratorn\u00edmi testy<\/strong><\/p>\n Standardn\u011b se zji\u0161\u0165uje EKG, prov\u00e1d\u00ed rtg plic, rozbor krve a mo\u010di. D\u00e1le je mo\u017en\u00e9 pomoc\u00ed modern\u00edch zobrazovac\u00edch metod neinvazivn\u011b „nahl\u00e9dnout“ do mozku a zjistit, co se v n\u011bm d\u011bje; k tomu slou\u017e\u00ed po\u010d\u00edta\u010dov\u00e1 tomografie (CT), magnetick\u00e1 rezonance (MRI) nebo metody zobrazuj\u00edc\u00ed mozkov\u00fd metabolismus \u2013 SPECT (single photon emission CT = jednofotonov\u00e1 emisn\u00ed po\u010d\u00edta\u010dov\u00e1 tomografie) \u010di PET (pozitronov\u00e1 emisn\u00ed tomografie).<\/p>\n","protected":false},"excerpt":{"rendered":" S demenc\u00ed se \u017e\u00e1dn\u00fd \u010dlov\u011bk nenarod\u00ed, ale a\u017e p\u011btina senior\u016f mezi 75 a 84 lety v\u011bku s n\u00ed um\u00edr\u00e1. P\u0159\u00ed\u010dinou je zhruba v 60\u00a0% p\u0159\u00edpad\u016f […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":21033,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-15496","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/15496","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=15496"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/15496\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/21033"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=15496"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=15496"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=15496"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}