Disertasi

INTERVENSI TARI POCO-POCO TERHADAP FUNGSI EKSEKUTIF PENYANDANG DM TIPE 2 DENGAN HENDAYA KOGNITIF RINGAN MELALUI PERBAIKAN FUNGSI DAN PLASTISITAS NEURON.

Pendahuluan : Peningkatan produksi Reactive Oxigen Species (ROS) pada penyandang DM tipe 2 dapat berakibat terjadinya destruksi sel termasuk sel neuron yang dapat menyebabkan gangguan fungsi eksekutif. Fungsi eksekutif penting untuk dipertahankan agar seseorang dapat menjalankan aktivitas sehari-hari dengan baik. Untuk mempertahankan atau memperbaiki fungsi eksekutif diperlukan intervensi yang mudah, praktis dan murah misalnya menari poco-poco agar seseorang hidup sehat dan mandiri sehingga kualitas hidup dapat terpelihara baik. Tari poco-poco merupakan tarian rakyat yang populer saat ini, mudah dilakukan, murah, sopan sesuai dengan norma budaya Indonesia, diperkirakan mempunyai nilai aerobik yang dapat meningkatkan atau mempertahankan fungsi eksekutif penyandang DM tipe 2 Subjek dan metode : Penyandang DM tipe 2 dengan hendaya kognitif ringan di Kota Depok. Uji eksperimental intervensi tari poco-poco dengan desain randomized controlled trial (RCT). Penelitian ini dilakukan pada bulan Desember 2013-Juli 2014. Jumlah responden 32 orang, usia 45-59 tahun, minimal tamat SMP, tidak memiliki hendaya melakukan kegiatan fisik. Kedua kelompok diberikan terapi standar berupa senam dan penyuluhan kesehatan 1 kali seminggu. Skrining menggunakan Hendaya Kognitif Vaskular Non Demensia Diabetes Melitus Tipe 2 (HKVND DM T2). Semua subjek dilakukan pemeriksaan laboratorium HbA1c, Low Density Lipoprotein (LDL), trigliserida, kolesterol total, F Isoprostan dan rasio metabolit otak N Asetil Aspartat/Kreatin (NAA/Kr) dengan Magnetic Resonance Spectroscopy (MRS) sebelum dan sesudah intervensi. 2 Hasil : Kelompok menari poco-poco berbeda bermakna pada tes psikometrik Trail Making Test B (TMT B) (p=0,016), HbA1c (p=0,020), LDL (p=0,003), trigliserida (p=0,002) dan F Isoprotan (p=0,001), serta rasio NAA/Kr di prefrontal kanan (p=0.001), prefrontal kiri (p=0,001), parietal kiri (p=0,007) dan hippokampus kanan (p=0,003) sebelum dan sesudah intervensi tari poco–poco. Kelompok kontrol terdapat perbedaan bermakna terhadap HbA1c (p=0,001) dan F Isoprostan (p=0,001), tidak terdapat perbedaan bermakna pada tes TMT B (p=0,99) dan rasio NAA/Kr menurun di semua lobus. Penyandang DM tipe 2 dengan hendaya kognitif ringan yang mendapat intervensi tari poco-poco akan membaik fungsi eksekutifnya sebesar 37,5% dibandingkan kelompok kontrol. Simpulan : Menari poco-poco 2 kali seminggu selama 12 minggu dapat memperbaiki fungsi eksekutif melalui perbaikan plastisitas neuron otak penyandang DM tipe 2 dengan hendaya kognitif ringan.
Kata kunci : DM tipe 2, fungsi eksekutif, hendaya kognitif ringan, plastisitas, tari poco-poco.


Introduction: An increase in the production of reactive oxygen species (ROS) and free radicals in people with type 2 diabetes results in destruction of cells including neuron and leads to impaired executive function. Executive function is important to be maintained so that persons can perform their functions properly. To maintain or improve executive function, an intervention which is easy, practical and non-expensive is required, which can be in a form of dance so that one can live healthy and independent in order to achieve maintainable quality of life. Poco-poco dance is a folk dance that is popular today, easy to do, inexpensive, and in courteous accordance with Indonesian cultural norms is estimated to have a value of aerobics that may improve or maintain executive function. Subjects and Methods: The subjects were citizens of Depok with type 2 diabetes mellitus and mild cognitive impairment. Experimental test interventions with poco-poco dance were designed as randomized controlled trials (RCTs). This study was conducted in December 2013-July 2014. The respondents, a number of 32 people, aged 45-59 years, at least junior high school graduation, had no impairment of physical activity. Screening used HKVND DM T2. All subjects performed laboratory tests HbA1c, LDL, triglycerides, total cholesterol, F -isoprostane and brain metabolite ratios NAA/Cr with MRS before and after intervention. 2 Results: There were significant differences in psychometric tests TMT B (p=0.016), HbA1c (p=0.020), LDL (p=0.003), triglycerides (p=0.002) and F -isoprotane (p=0.001) and NAA/Cr ratios in the right prefrontal (p=0.001), left prefrontal (p=0.001), left parietal (p=0.007) and right hippocampus (p=0.003) before and after poco-poco dance intervention. In the control group there were significant differences in HbA1c (p=0.001) and F 2 2 -isoprostane (p=0.001) and no significant differences in TMT B (p=0.99) and in NAA/Cr ratios of all lobes. People with type 2 diabetes mellitus who danced poco-poco improved their executive function by 37.5% versus controls. Conclusions: Performing Poco-poco dance twice a week for 12 weeks can improve executive function through brain plasticity in people with type 2 diabetes mellitus and mild cognitive impairment.
Keywords: executive function, mild cognitive impairment, neuroplasticity, poco-poco dance, type 2 diabetes.