Disertasi

Deteksi Dini Hendaya KognitifRingan Tipe Amnestik pada Lansia : Peningkatan Keakuratan Melalui Kombinasi Perneriksaan Saraf Olfaktorius, Tes Respons Pupil, Kadar Plasma Brain-Derived Neurotrophic Factor, dan Genotip APOE. = Early Detection of aMCI in the Elderly: enhancing diagnostic accuracy through combination of Olfactory Test, Pupillary Response Test, BDNF plasma level, and APOE genotype.

Pendahuluan. Hendaya kognitif ringan tipe amnestik (aHKR) merupakan prademensia Alzheimer. Tampak ada beberapa penanda klinis dan biologis proses degeneratif di otak. Tujuan. Mengetahui nilai diagnostik pemeriksaan saraf olfaktorius, respons pupil terhadap tropikamid 0,01 %, kadar plasma BDNF, dan APOE c4 dalam diagnosis aHKR. Metode. Desain potong lintang, analitik komparatif. Hasil, Jumlah sampel: 109 subjek (aHKR: 51, kognitif normal: 58). Usia 64 ± 5,54 tahun, mayoritas tidak tamat SD (40 %). Didapatkan nilai olfaktorius < 7 dari total 10 (Sensitivitas/Sv 73 %, Spesifisitas/Sp 81 %, Nilai Duga PositiflNDP 77 %) dan nilai ~23 % pelebaran pupil (Sv 86 %, Sp 78 %, NDP 77 %) untuk mendiagnosis aHKR. Kadar BDNF rendah berhubungan dengan defisit saraf olfaktorius dan aHKR (p < 0,05). Empat dari 5 subjek dengan homozigot £4 merupakan aHKR ranah multipel. Tipe aHKR ranah multipel mempunyai rerata nilai olfaktorius dan hipersensitivitas respons pupil terburuk (p < 0,0001). Kombinasi defisit saraf olfaktorius dan hipersensitivitas respons pupil mempunyai Sp 91 %, dan NDP 87 % untuk mendeteksi aHKR. Adanya kadar BDNF rendah dan APOE £4+ menambah nilai diagnostik aHKR. Simpulan. Kombinasi pemeriksaan saraf olfaktorius dan respons pupil terhadap tropikamid 0,01 % mernpunyai nilai diagnostik aHKR. Kadar BDNF rendah dan APOE £4 menambah nilai diagnostik penanda klinis.
Kata kunci. APOE, BDNF, Hendaya Kognitif Ringan tipe Amnestik, Respons Pupil, Saraf Olfaktorius, Tropikamid.



Background. Amnestic mild cognitive impairment CaMCI) often progresses to Alzheimer's disease. There are clinical markers and biomarkers to identify the degenerative process in the brain. Objectives. To obtain the diagnostic values of olfactory test, pupillary response to tropicamide 0.01 %, BDNF plasma level, and APOE 1':4 in diagnosing aMCI. Methods. Cross-sectional, comparative-analytical Results. There were 109 subjects enrolled CaMCI: 51, normal cognition: 58) with age 64 ± 5.54 years, 40 % subjects only completed < 6 years of education. For diagnosing aMCI, cut-off point for the olfactory score was < 7 out of 10 (Sensitivity/Sv 73 %, Specificity/Sp 81 %, Positive Predictive Value/PPV 77 %) and 2::23 % for pupil dilatation response (Sv 86 %, Sp 78 %, PPV 77 %). Low BDNF plasma level was related significantly with olfactory deficits and aMCI (p < 0.05). Four of five subjects with homozygote 1':4presented with multiple-domain aMCI. This group of multiple-domain aMCI displayed the lowest means of olfactory score and highest means of pupillary hypersensitivity response (p < 0.0001). Combination of olfactory deficit and pupillary hypersensitivity response in detection of aMCI was beneficial with Sp 91 % and PPV 87 %. In conjunction with clinical markers, low BDNF plasma level and presence of APOE 1':4+ improved Sp and PPV in detecting aMCI. Conclusions. Combination of olfactory test and pupillary response to tropicamide 0.01 % was useful as diagnostic tool in aMCI. In conjunction with clinical markers, low BDNF plasma level, and presence of APOE 1':4 improved the diagnostic value.
Keywords. Amnestic Mild Cognitive Impairment, APOE, BDNF, Olfactory, Pupillary Response, Tropicamide.