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Manifestasi Klinis dan Gambaran Pencitraan Struktural dan Fungsional Berbagai Subtipe Demensia Valentina Tjandra Dewi; Anak Agung Ayu Putri Laksmidewi
Cermin Dunia Kedokteran Vol 50 No 11 (2023): Pediatri
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v50i11.836

Dementia causes impaired cognition, behavior, and daily functional activities with physical, mental, and psychosocial consequences for patients, families, and communities. However, dementia diagnosis is still challenging. Classification of dementia subtypes also requires structuraland functional imaging studies. The structural imaging needed to support Alzheimer’s dementia and vascular dementia diagnosis is brain magnetic resonance imaging (MRI), frontotemporal dementia diagnosis can be supported by brain MRI or functional imaging, while Lewy Body dementia diagnosis requires functional imaging and biomarkers findings.

PREVALENSI MIGREN DAN KOMORBIDITAS DEPRESI PADA MAHASISWA PROGRAM STUDI SARJANA KEDOKTERAN DAN PROFESI DOKTER FAKULTAS KEDOKTERAN UNIVERSITAS UDAYANA Tirtha, Putu Bagus Bramanthana; Adnyana, I Made Oka; Putra, Ida Bagus Kusuma; Laksmidewi, Anak Agung Ayu Putri
E-Jurnal Medika Udayana Vol 11 No 2 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.V11.i02.P09

Introduction: Depression is one of the world’s major causes of disability, and the comorbidity of depression with migraine can worsen the patient's prognosis. By studying this comorbidity, the treatment quality can be improved. In addition, data regarding comorbidity of migraine and depression among students in Bali are still limited. Method: This is a descriptive analytic cross-sectional research. The sample population are pre-clinical students of the Undergraduate Program of Medicine and Medical Profession, Faculty of Medicine, Udayana University, aged 18 to 22 years. The total sample is 100 people. The purpose of this research is to describe the prevalence of migraine and depression in the sample population, and to understand whether there is a relationship between the prevalence of migraine and the prevalence of depression. This study used a questionnaire containing questions about headache status, depression status, and confounding variables status (gender, menstrual period, eating and drinking patterns, and socioeconomic status). Result and discussion: Migraine prevalence is 7%, and depression prevalence is 4%. 42,9% of the people who have migraine also have depression. 1,1% of the people who did not have migraine have depression. 2-sided P = 0.001 is derived from Fischer’s Exact Test. Conclusion: There is a relationship between migraine prevalence and depression prevalence.

CASE REPORT OF ADULT-ONSET CHARCOT MARIE TOOTH TYPE X Suherlim, Richard; Laksmidewi, Anak Agung Ayu Putri; NKA, Sudiarini
MNJ (Malang Neurology Journal) Vol. 8 No. 1 (2022): January
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2022.008.01.14

Charcot-Marie-Tooth (CMT) or Hereditary Motor and Sensory Neuropathy (HMSN) is the most common hereditary peripheral nerve disease with progressive chronic weakness, muscle atrophy, and sensory disturbances. There are several types and subtypes of CMT with their respective clinical manifestations. In this article, we reported a patient with of CMT type X. A 43-year-old male patient was referred to a neurology clinic with weakness in both limbs for 2 years, accompanied by tingling and sensory disturbance in both hands and feet. There are several of his family members who had similar complaints. Lumbosacral magnetic resonance imaging (MRI) examination revealed mild nucleus pulposus herniation. Electroneuromyography (ENMG) examination revealed demyelinating sensory motor polyneuropathy. Histopathological examination of nerve biopsy showed demyelination of the sural nerve. It is hard to make a diagnosis of CMT, because it requires high suspicion from clinicians once encounter a suspected case and also need to supported by sophisticated equipment such as electrophysiological examinations, nerve biopsy examinations, and genetic examinations. It is vital for clinicians for being able to diagnose CMT correctly and provide treatment as soon as possible in order to maintain the patientsâ€™ quality of life.

PSEUDOBULBAR AFFECT AND COGNITIVE DECLINE POST SEVERE TRAUMATIC BRAIN INJURY: A CASE REPORT Yusari, I Gusti Agung Ayu Andra; Laksmidewi, Anak Agung Ayu Putri
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.02.15

Introduction: Pseudobulbar affect is described as episodes of laughing or crying that occur suddenly and uncontrollably without appropriate stimulation. Pseudobulbar affect is often preceded by various neurological disorders, one of which is a history of severe head injury. Case Report: Female, 21 years old, experienced sudden frequent laughing for no apparent reason and could not be controlled. This has been happening after she suffered a severe head injury, which was a subarachnoid hemorrhage, about two years ago. She was diagnosed with pseudobulbar affect according to Cummings criteria and confirmed by Center for Neurologic Study – Lability Scale (CNS-LS) questionnaire with a score of 19. The patient also complained of forgetting things, therefore a cognitive function was examined with Indonesian Version of the Montreal Cognitive Assessment (MoCA-Ina) with a score of 14 which indicated moderate cognitive impairment. Discussion: Pseudobulbar affect post traumatic brain injury is suspected to be caused by decreased inhibition of sensory cortex transmission to the motor cortex and limbic system leading to disturbances in the cerebellum and decreased threshold for emotional expression. Pseudobulbar affect may coexist with impaired cognitive function due to the intersection of the anatomical structure of cognitive function with pathways that regulate emotion. Conclusion: Pseudobulbar affect with cognitive impairment creates a burden and interferes the patient’s quality of life. It is necessary for health workers to be able to identify the clinical manifestations of pseudobulbar affect as a complication after traumatic brain injury, therefore optimal management for the patients can be achieved.

COGNITIVE FUNCTION ASPECTS IN HIV-ASSOCIATED CEREBRAL TOXOPLASMOSIS: A CASE REPORT Lasta Arshinta; Anak Agung Ayu Putri Laksmidewi; Ni Wayan Nurlina Ekasari; Dian Kusumastuti Anggraeni Putri; Gede Suputra; Bagus Ngurah Mahasena Putera Awatara
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.02.18

HIV-associated cerebral toxoplasmosis may lead to cognitive function impairment through accumulation of β-amyloid plaques and Tau protein which cause damage, inflammatory and oxidative processes in the brain. A 40-year-old, Balinese, right-handed female patient, came with chief complaint of three times of seizure before admission. After the seizures stopped, the patient was fully conscious again. Since the last 2 months, the patient seemed more confused and spoke a little slower. The patient also often repeated a story about something and forgot that she had already told it. The patient has a known history of HIV infection in the past 3 months before admission, she had taken anti-retroviral agents but she stopped them by herself since last 1 month. Anti-Toxoplasma IgG antibody showed reactive results and CD-4 of 62 cells/µL. The results of the overall cognitive function examination found mild cognitive impairment with activities that required mild assistance. HIV-associated neurocognitive disorders (HAND) are still a challenge to study, and the importance of improving patient cognitive function to maintain or increase aspects of independence and quality of life is a target in the care of HIV patients, especially patients with HIV-associated cerebral toxoplasmosis infection.

EFFECT OF BALINESE FLUTE INSTRUMENT FOR IMPROVING COGNITIVE FUNCTION IN ELDERLY Laksmidewi, Anak Agung Ayu Putri; Tertia, Clarissa; Indah, Carolin Tiara Lestari; Suherlim, Richard; Arshinta, Lasta; Mahadewi, Ni Putu Ayu Putri
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.02.05

Background: Cognitive impairment is mostly affected the elderly population which reduces the quality of life for sufferers and their families. The last research showed that listening to Balinese flute instrument music increased cognitive function, especially in the memory domain. However, the study is still limited to small populations. Objective: to determine whether playing the Balinese flute with or without listening to the "Morning Happiness" song affects the cognitive function of elderly. Methods: This experimental study was conducted on healthy geriatric patients above 55 years old with controlled risk factors or no history of any chronic conditions which were divided into 2 groups. The "Morning Happiness" song will be played with Balinese flute instrument in both groups whereas the intervention will add to listen to similar songs. Results: 28 subjects in the intervention group and 20 subjects in the control group. Both groups were comprised of typical gender distribution with an average of 65.08±6.41 years old. Both the intervention and control groups had improved in MoCA-Ina (The Indonesian Version of Montreal Cognitive Assessment) scores, but the intervention group gained a better Z-score (-3.193, p-value 0.001) than the control group (-1.466, p-value 0.143) after procedural. The delayed recall domain also showed significant improvement in both groups with a Z-score of -3.241 (p-value 0.001) in control and -2.30 (p-value 0.026) in intervention group respectively. Interestingly, the attention domain is improved in the control group with a Z-score of -2.142 (p-value 0.032) rather than in intervention group. Conclusion: The overall MoCa-Ina score was significantly higher in interventional subjects than control, specifically in the delayed recall domain.

Prediktor Klinis dan Pencitraan Hematoma Subdural Kronik pada Pasien Lanjut Usia di Instalasi Gawat Darurat Vania, Aurelia; Arimbawa, I Komang; Laksmidewi, Anak Agung Ayu Putri; Putra, Ida Bagus Kusuma; Widyantara, I Wayan
Bahasa Indonesia Vol 23 No 3 (2024): Damianus Journal of Medicine
Publisher : Atma Jaya Catholic University of Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25170/djm.v23i3.5416

Pendahuluan: Subdural hematoma kronik (cSDH) merupakan salah kasus emergensi neurologi yang sering terjadi yang lebih sering terjadi pada lansia. Diagnosis cSDH memiliki kesulitan tersendiri pada pasien lansia. Studi ini bertujuan untuk mempelajari karakteristik klinis pasien lansia yang dapat menjadi prediktor adanya cSDH dan derajat keparahan gambaran cSDH yang ditemukan pada hasil CT-scan kepala. Metode: Penelitian ini merupakan studi kasus-kontrol yang dilakukan di Instalasi Gawat Darurat Neurologi RSUP Prof. dr. I.G.N.G. Ngoerah dalam periode 3 tahun. Studi melibatkan 85 pasien lansia cSDH dan 85 kontrol yang terbukti tidak ada perdarahan intrakranial dari data imaging. Pengumpulan dan pengolahan data yang dilakukan meliputi variabel karakteristik demografi, faktor risiko, presentasi klinis, dan karakteristik cSDH pada gambaran computed-tomography scan (CT-scan) kepala. Hasil: Studi ini menemukan pasien cSDH dengan rata-rata usia 72,9±8.1 tahun dan 75,3% laki-laki. Penurunan kesadaran dan defisit fokal merupakan presentasi klinis yang paling sering ditemukan dengan median onset 3 hari (rentang 1-30 hari). Usia lebih tua, laki-laki (RO=2,84, 95% IK 1,45-5,45, p=0,001), hipertensi (RO=3,66, 95% IK 1,89-7,06, p=0,000), dan gangguan ginjal kronik (RO=2,77, 95% IK 1,34-5,72, p=0,005) merupakan faktor risiko terjadinya cSDH yang signifikan. Efek massa dan Glasgow Coma Scale (GCS) yang rendah lebih sering terjadi pada cSDH dengan midline shift (MLS) >5mm. Simpulan: Adanya cSDH perlu dipertimbangkan pada pasien lansia yang datang dengan onset manifestasi neurologis akut-subakut terutama pasien laki-laki, mengalami penurunan kesadaran dengan atau tanpa defisit fokal, disertai adanya komorbid hipertensi dan gangguan ginjal. Penurunan GCS dan efek massa dapat memperkirakan adanya MLS pada CT-scan kepala.

Manifestasi Klinis dan Gambaran Pencitraan Struktural dan Fungsional Berbagai Subtipe Demensia Valentina Tjandra Dewi; Anak Agung Ayu Putri Laksmidewi
Cermin Dunia Kedokteran Vol 50 No 11 (2023): Pediatri
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v50i11.836

Dementia causes impaired cognition, behavior, and daily functional activities with physical, mental, and psychosocial consequences for patients, families, and communities. However, dementia diagnosis is still challenging. Classification of dementia subtypes also requires structuraland functional imaging studies. The structural imaging needed to support Alzheimer’s dementia and vascular dementia diagnosis is brain magnetic resonance imaging (MRI), frontotemporal dementia diagnosis can be supported by brain MRI or functional imaging, while Lewy Body dementia diagnosis requires functional imaging and biomarkers findings.

A Rare Case of Anomic Aphasia and Gerstmann Syndrome Induced by Hemorrhagic Stroke Mahendrakrisna, Daniel; Bagus Ngurah Mahasena Putera Awatara; Gede Suputra; Ni Wayan Nurlina Ekasari; Dian Kusumastuti Anggraeni Putri; Anak Agung Ayu Putri Laksmidewi
Magna Neurologica Vol. 3 No. 2 (2025): July
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v3i2.2262

Background: Aphasia is a language disorder caused by brain damage, such as a stroke. Anomic aphasia, a rare subtype, impairs the ability to name objects or people while preserving fluency and comprehension. It is often associated with Gerstmann syndrome, which is characterized by acalculia, finger agnosia, left-right disorientation, and semantic aphasia. This report presents a case of a 61-year-old male with anomic aphasia and Gerstmann syndrome following a hemorrhagic stroke. Case: A 61-year-old male patient presented with sudden difficulty recalling the names of family members and objects. Imaging revealed an intracerebral hemorrhage in the left parietotemporooccipital lobe. The patient also exhibited left-right disorientation and finger agnosia, indicative of Gerstmann syndrome. The Aphasia Test for Rehabilitation Information Diagnosis (TADIR) confirmed the diagnosis of anomic aphasia. Although conservative treatment led to partial improvement, naming difficulties and associated deficits persisted. Discussion: Anomic aphasia primarily involves difficulties with naming, typically resulting from lesions in the dominant hemisphere, particularly the temporal and parietal lobes. Its coexistence with Gerstmann syndrome underscores the complexity of overlapping neurological deficits. The TADIR test was crucial in diagnosing and managing the patient's condition. Conclusion: This case highlights the importance of a thorough evaluation in aphasia cases, especially when rare syndromes like Gerstmann syndrome are involved. Early and accurate diagnosis enables targeted interventions that can improve patient outcomes.

The Synergistic Impact of Astrocyte Reactivity and Vitamin D Deficiency on Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis Patricia; Anak Agung Ayu Putri Laksmidewi; Kumara Tini
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1449

Background: Post-stroke cognitive impairment (PSCI) is a common, debilitating outcome of ischemic stroke. Glial Fibrillary Acidic Protein (GFAP), marking astrocyte reactivity, and Vitamin D, a neuro-immunomodulatory steroid, are independently linked to PSCI. This study aimed to quantify the synergistic impact of elevated serum GFAP and concurrent Vitamin D deficiency on PSCI risk. Methods: Following PRISMA guidelines, a systematic search of PubMed, Scopus, and Web of Science was conducted for prospective cohort studies (2015-2025) assessing acute serum GFAP, 25-hydroxyvitamin D (25(OH)D), and subsequent cognitive outcomes in ischemic stroke patients. Quality was assessed using the Newcastle-Ottawa Scale. A meta-analysis of seven studies (n=3,850) was performed using a random-effects model to calculate pooled odds ratios (ORs) for PSCI across four biomarker-defined groups. A formal test for synergistic interaction was conducted by assessing the departure from additivity of effects on the log-odds scale. Results: Seven high-quality studies were included. Compared to the reference group (Normal GFAP/Sufficient Vitamin D), the pooled OR for PSCI was 2.18 (95% CI: 1.85-2.57) for high GFAP alone and 1.95 (95% CI: 1.65-2.30) for Vitamin D deficiency alone. For the dual-biomarker group (High GFAP/Deficient Vitamin D), the pooled OR was 4.75 (95% CI: 3.98-5.67). This observed risk was significantly greater than the 3.13 OR expected from a purely additive model (p for interaction < 0.001), confirming a significant synergistic effect. Sensitivity analysis showed the effect was most pronounced in patients with moderate-to-severe strokes (NIHSS > 5). Conclusion: Elevated serum GFAP and Vitamin D deficiency synergistically increase the risk of PSCI, particularly in patients with more severe strokes. The interplay between acute astroglial injury and compromised systemic neuroprotection appears to be a critical determinant of cognitive outcomes. While confounding by patient frailty requires further study, this dual-biomarker profile identifies a high-risk subgroup and highlights a key pathophysiological interaction.

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