{"id":14571,"date":"2023-03-16T15:09:01","date_gmt":"2023-03-16T15:09:01","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=14571"},"modified":"2023-03-16T15:38:58","modified_gmt":"2023-03-16T15:38:58","slug":"interviu-profesor-gabriel-ioan-prada","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/interviu-profesor-gabriel-ioan-prada\/","title":{"rendered":"Interviu cu prof. dr.\u00a0 Gabriel Ioan Prada \u2013 pre\u0219edinte Societatea Rom\u00e2n\u0103 de Gerontologie \u0219i Geriatrie"},"content":{"rendered":"

<\/h3>\n

\u201eMedicii de familie au un rol esen\u021bial<\/strong>\u201d<\/strong><\/h3>\n

\u00cenaintarea \u00een v\u00e2rst\u0103 presupune, printre altele, o mai mare grij\u0103 pe care trebuie s-o acord\u0103m s\u0103n\u0103t\u0103\u021bii.<\/em><\/p>\n

Fenomenul de\u00a0\u00eemb\u0103tr\u00e2nire\u00a0este un proces complex care poate varia de la o persoan\u0103 la alta \u0219i care poate aduce modific\u0103ri at\u00e2t \u00een ceea ce prive\u0219te felul \u00een care ar\u0103t\u0103m, c\u00e2t \u0219i \u00een ceea ce prive\u0219te felul \u00een care organismul nostru lucreaz\u0103. De cele mai multe ori apar \u0219i tulbur\u0103rile de dispozi\u021bie, care pot avea impact asupra altor afec\u021biuni ale persoanei v\u00e2rstnice.<\/em><\/p>\n

Depresia, este una din cele mai des \u00eent\u00e2lnite afec\u021biuni deoarece modific\u0103rile aduse de aceasta sunt greu de acceptat de pacien\u021bi.<\/em><\/p>\n

Vom discuta despre problemele v\u00e2rstei a treia precum \u0219i despre problemele neurocognitive cel mai des \u00eent\u00e2lnire la aceast\u0103 categorie de persoane cu domnul prof. dr. Gabriel Ioan Prada, pre\u0219edintele Societ\u0103\u021bii Rom\u00e2ne de Gerontologie \u0219i Geriatrie.<\/em><\/p>\n

\"\"<\/strong><\/p>\n

C\u00e2t de important\u0103 este implicarea medicilor de familie \u00een orientarea v\u00e2rstnicilor c\u0103tre centrele de geriatrie \u0219i gerontologie?<\/strong><\/p>\n

Medicii de familie au un rol esen\u021bial, pentru c\u0103 ei a\u0219a cum de multe ori s-a spus, reprezint\u0103 o plac\u0103 turnant\u0103 pentru pacient, \u0219i inclusiv pentru pacientul v\u00e2rstnic care are de regul\u0103 o pluripatologie cu multiple asocieri morbide, ceea ce necesit\u0103 o integrare a acestor probleme, \u0219i \u00een plus, pacientul v\u00e2rstnic are particularit\u0103\u021bi ale bolilor care adesea \u00eent\u00e2rzie diagnosticul \u0219i bolile ajung s\u0103 fie identificate \u00een stadii avansate. De aceea, o colaborare str\u00e2ns\u0103 \u00eentre medicul de familie \u0219i cel geriatru ar fi \u00een primul r\u00e2nd \u00een beneficiul pacientului.<\/p>\n

Care sunt cel mai des \u00eent\u00e2lnite deregl\u0103rile cognitive \u00een r\u00e2ndul persoanelor de v\u00e2rsta a treia?<\/strong><\/p>\n

Problemele acestea cognitive au o serie de caracteristici la v\u00e2rstnici, au o prevalen\u021b\u0103 mai mare dup\u0103 v\u00e2rsta de 65 de ani, sunt mai frecvente o dat\u0103 cu \u00eenaintarea \u00een v\u00e2rst\u0103. Unele studii care au fost f\u0103cute sistematic, arat\u0103 c\u0103 aproape jum\u0103tate dintre persoanele cu v\u00e2rsta de peste 85 de ani au o form\u0103 de tulburare neurocognitiv\u0103, aici a\u0219 da ca exemplu studiile f\u0103cute \u00een Marea Britanie.<\/p>\n

Din p\u0103cate, diagnosticul bolilor neurodegenerative care conduc la demen\u021b\u0103 este stabilit \u00een stadiu avansat de demen\u021b\u0103 \u0219i s-a constatat c\u0103 ele debuteaz\u0103 cu mult \u00eenainte \u00een cazul bolii Alzheimer, aici debutul are loc \u00een urm\u0103 cu 20-30 de ani \u00eenainte de diagnosticul incipient al bolii.<\/p>\n

Uneori la v\u00e2rstnic apare o problem\u0103 pentru c\u0103 tulbur\u0103rile neurocognitive se pot confunda cu afec\u021biuni frecvent \u00eent\u00e2lnite la acest\u0103 categorie de v\u00e2rst\u0103 \u0219i anume depresia. Persoanele care au depresie sunt apatice, letargice \u0219i la o prima evaluare, seam\u0103n\u0103 cu pacien\u021bii care au tulbur\u0103ri neurocognitive dar la cei cu depresie se observ\u0103 idea\u021bia aceasta care domin\u0103 g\u00e2ndirea pacientului. La subiec\u021bii cu demen\u021b\u0103 nu exist\u0103 aceast\u0103 idea\u021bie, s-au exist\u0103 mult mai estompat\u0103 pentru c\u0103 la cei cu form\u0103 incipient\u0103, depresia se asociaz\u0103 cu tulburarea neurocognitiv\u0103, dar apatia are sursele \u00een alte cauze \u0219i anume, \u00een faptul c\u0103 ei nu mai \u00een\u021beleg cum s\u0103 se \u00eencadreze \u00een mediul \u00eenconjur\u0103tor, nu mai au interes pentru o serie de lucruri.<\/p>\n

Pute\u021bi s\u0103 ne descrie\u021bi cauzele demen\u021bei la v\u00e2rstnici?<\/strong><\/p>\n

Cauzele dementei sunt greu de identificat pentru c\u0103 \u00een general, marea majoritate a bolilor au factori favorizan\u021bi, nu cauze \u0219i m\u0103 refer la bolile cronice de la v\u00e2rstnici, \u0219i \u00een principiu, se poate stabili cu certitudine o cauz\u0103, mai ales la bolile infec\u021bioase unde se poate face leg\u0103tura \u00eentre un anumit agent patogen \u0219i semnele, simptomele pe care le reprezint\u0103 pacientul respectiv.<\/p>\n

\u00cen cazul demen\u021bei, nu putem vorbi de factori cauzan\u021bi, ci de factori favorizan\u021bi ai acestei tulbur\u0103ri. Ce este interesant, este c\u0103 la forma degenerativ\u0103 de tip Alzheimer, exist\u0103 factori comuni cu form\u0103 vascular\u0103 de demen\u021b\u0103 \u0219i sunt 4 factori importan\u021bi: hipertensiunea arterial\u0103, diabetul zaharat, obezitatea \u0219i hipercolesterolemia. Ace\u0219ti factori pot fi controla\u021bi, de exemplu, hipertensiunea este important s\u0103 fie identificat\u0103 din timp, pe de o parte, mul\u021bi pacien\u021bi o diagnosticheaz\u0103 \u00een stadii avansate, \u0219i pe alt\u0103 parte, s\u0103 reu\u0219im s\u0103 cre\u0219tem complian\u021ba, s\u0103 men\u021binem terapia astfel \u00eenc\u00e2t s\u0103 ob\u021bin\u0103 un nivel sc\u0103zut, obezitatea \u0219i diabetul zaharat sunt boli care pot fi prevenite \u0219i tratate, la fel \u0219i dislipidemia, deci to\u021bi ace\u0219ti factori de risc ar putea s\u0103 fie controla\u021bi din timp \u0219i influen\u021ba\u021bi.<\/p>\n

Putem discuta de tratament \u00een cazul bolii Alzheimer ?<\/strong><\/p>\n

Exist\u0103 mai multe tipuri de tratament, \u00een general, sunt tratamente simptomatice care sunt adresate mai ales manifest\u0103rilor bolilor respective \u0219i care ar putea s\u0103 influen\u021beze sau s\u0103 modifice evolu\u021bia bolii. Din p\u0103cate, \u00een cazul bolii Alzheimer nu avem instrumente terapeutice care s\u0103 modifice evolu\u021bia acestei afec\u021biuni, avem doar un arsenal de medicamente cu efect dar nu simptomatic care pe de alt\u0103 parte, pot s\u0103 \u0219i \u00eencetineasc\u0103 evolu\u021bia spre stadii avansate, dar din p\u0103cate, evolu\u021bia aceste boli nu poate fi oprit\u0103.<\/p>\n

Cum se situeaz\u0103 Rom\u00e2nia comparativ cu alte \u021b\u0103ri din Europa din punct de vedere al \u00eengrijirilor bolnavilor cu demen\u021b\u0103?<\/strong><\/p>\n

Din p\u0103cate, nu exist\u0103 un sistem coerent de \u00eengrijire \u00een acest sens, exist\u0103 o serie de ini\u021biative private care reu\u0219esc s\u0103 rezolve par\u021bial problemele, dar ar fi nevoie de un sistem bine structurat care s\u0103 fie \u0219i de tip progresiv \u0219i \u00een func\u021bie de stadiul \u00een care se afl\u0103 pacientul s\u0103 ofere un serviciu adecvat lui.<\/p>\n

Pute\u021bi s\u0103 ne vorbi\u021bi despre rolul tehnologiilor digitale \u00een prevenirea evolu\u021biei demen\u021bei?<\/strong><\/p>\n

Tehnologiile digitale sunt foarte importante pentru via\u021ba noastr\u0103 de zi cu zi. Problema esen\u021bial\u0103 care apare este c\u0103 ele ar trebui adaptate la nevoile pacientului. Din p\u0103cate, am v\u0103zut multe ini\u021biative de utilizare tehnologic\u0103 a inteligen\u021bei artificiale, nu \u0219tiu dac\u0103 ar putea s\u0103 previn\u0103 efectiv boala, dar ar putea s\u0103 ajute \u00een \u00eengrijirea pacien\u021bilor.<\/p>\n

Exist\u0103 o problem\u0103 \u0219i anume, c\u0103 din p\u0103cate, nu sunt aplicate \u00een practic\u0103 la nivel extins \u0219i nu \u021bin cont de nevoile pacientului. Sunt concepute \u00een a\u0219a fel \u00eenc\u00e2t s\u0103 satisfac\u0103 ni\u0219te impresii ale persoanelor din afar\u0103, f\u0103r\u0103 s\u0103 se evalueze exact nevoile pacientului \u00een primul r\u00e2nd, dar \u0219i ale persoanelor care asigur\u0103 \u00eengrijirea.<\/p>\n

Dac\u0103 s-ar porni invers, de la studii care s\u0103 evalueze cu acurate\u021be nevoile acestui tandem dintre pacient si persoana care asigur\u0103 \u00eengrijirea, cred c\u0103 tehnologiile moderne s-ar putea adapta mai bine la nevoile lor.<\/p>\n

Nu cred c\u0103 la momentul actual exist\u0103 posibilitatea de a preveni tulburarea neurognitiv\u0103, dar tehnologiile digitale ar putea fi extrem de utile \u00een suplinirea pierderilor func\u021bionale ale pacien\u021bilor.<\/p>\n

De cur\u00e2nd a\u021bi prezentat lucrarea – Abordarea multidimensional\u0103 a v\u00e2rstnicilor cu afectare neurocognitiv\u0103. Pute\u021bi s\u0103 ne oferi\u021bi c\u00e2teva detalii despre aceasta?<\/strong><\/p>\n

\u00cen cadrul acestei lucr\u0103ri am vorbit \u00een primul r\u00e2nd de multimorbiditate, de faptul c\u0103 pacientul \u00een v\u00e2rst\u0103 prezint\u0103 un cumul de afec\u021biuni, una dintre ele foarte frecvent\u0103 fiind aceast\u0103 tulburare neurocognitiv\u0103 \u0219i despre ce este caracteristic la pacientul \u00een v\u00e2rst\u0103 cu tulburare neurocognitiv\u0103 \u0219i anume, c\u0103 afec\u021biunile noi acute se pot manifesta cu simptomatologie nu la nivelul sistemului afectat, ci la nivelul unei a\u0219a numite verigi slabe, adic\u0103 la nivelul preafect\u0103rii cognitive, o infec\u021bie urinar\u0103, de exemplu, sau o tulburare de ritm cu frecven\u021b\u0103 rapid\u0103 care se poate manifesta nu cu simptome din sfera cardiac\u0103, ci cu agravare a unei tulbur\u0103ri neurognitive preexistente, de aceea este nevoie de o echipa multidisciplinar\u0103 care s\u0103 intervin\u0103 \u00een evaluarea pacientului.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u201eMedicii de familie au un rol esen\u021bial\u201d \u00cenaintarea \u00een v\u00e2rst\u0103 presupune, printre altele, o mai mare grij\u0103 pe care trebuie s-o acord\u0103m s\u0103n\u0103t\u0103\u021bii. Fenomenul de\u00a0\u00eemb\u0103tr\u00e2nire\u00a0este un proces complex care poate […]<\/p>\n","protected":false},"author":1,"featured_media":14583,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[276],"tags":[],"class_list":["post-14571","post","type-post","status-publish","format-standard","has-post-thumbnail","category-interviu"],"yoast_head":"\nInterviu cu prof. dr.\u00a0 Gabriel Ioan Prada \u2013 pre\u0219edinte Societatea Rom\u00e2n\u0103 de Gerontologie \u0219i Geriatrie - Jurmed - Medici<\/title>\n<meta name=\"description\" content=\"Depresia, este una din cele mai des \u00eent\u00e2lnite afec\u021biuni. Vom discuta despre aceast\u0103 afectiune cu domnul prof. dr. 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