Pencegahan dan Pengobatan Disfungsi Kognitif setelah Cedera Otak Traumatik

Abstract

Kognisi adalah proses untuk mengetahui atau berpikir, memilih, mengerti, mengingat, dan menggunakan informasi. Gangguan kognitif adalah gangguan dalam melakukan perhatian dan konsentrasi, proses dan mengerti informasi, ingatan, komunikasi, perencanaan, organisasi, pemikiran, pemecahan masalah dan pengambilan keputusan, mengendalikan rangsangan dan hasrat. Lebih dari 50.000 orang meninggal setiap tahun akibat cedera otak traumatik (COT) dan 70.000–90.000 mengalami kecatatan permanen di USA. Walaupun pasien dengan COT sedang, secara fisik mengalami pemulihan penuh, tapi sering mengalami perubahan tingkah laku jangka lama yang mempengaruhi pekerjaan, cara hidup, dan keluarganya. Setelah COT yang lebih berat, gangguan kognitif merupakan masalah paling umum dan memberikan kontribusi lebih daripada gangguan fisik. Luasnya defisit kognitif ditunjukkan oleh 1) beratnya diffuse axonal injury (DAI) yang ditunjukkan lamanya posttraumatic amnesia (PTA), luasnya atropi umum, dan 2) lokasi, dalamnya, dan volume lesi serebral fokal. Terapi difokuskan pada rehabilitasi neurokognisi. Sampai saat ini tidak ada terapi untuk cedera otak primer dan terapi yang dilakukan adalah mengurangi cedera sekunder yang dipicu oleh cedera primer. Jadi secara umum tetap menggunakan ABCDE neuroanestesi/neuroresusitasi dan secara khusus dengan pemberian infus lidokain, natrium laktat hipertonik, obat kholinergic, catecholaminergic, tricyclic antidepressants.

Prevention and Management of Cognitive Dysfunction after TBI

Cognition is the act of knowing or thinking process. It includes the ability to choose, understand, remember and use information. Cognition function disorder includes disturbances in accessing and optimizing attention and concentration, processing and understanding information, memory, communication, planning, organizing, and assembling, reasoning, problem-solving, decision-making, and judgment, controlling impulses, desires and being patient. More than 50,000 people die from traumatic brain injury (TBI) each year and other 70,000–90,000 people are permanently disabled in the US. Even individuals with moderate head injuries who appear to be physically fully recovered, often have long lasting behavioral sequelae, which in turn affects the individual’s occupation, lifestyle and interaction with family members. After a more severe injury, cognitive function disorder is considered more common compared to physical impairment. The extent of cognitive function deficit after TBI is reflected by a number of factors 1) the severity of diffuse axonal injury, as indicated by the length of post traumatic amnesia (PTA), the extent of generalized atrophy; and 2) the location, depth, and volume of focal cerebral lesions. Therapy is focused to neuro cognitive rehabilitation. Until now, there is no specific therapy for primary brain injury and commonly applied therapy is focused on reducing secondary brain injury. In general, the ABCDE of neuroanesthesia/neuroresuscitation is still commonly used, and in specific case, the need to administration of lidocaine infusion, sodium lactate hyperosmolar, cholinergic, catecholaminergic, and tricyclic antidepressants.