GHID din 30 noiembrie 2010

de practic medical pentru specialitatea geriatrie i gerontologie*) practic de utilizare - Evaluarea geriatric"
EMITENT:
MINISTERUL SNTII
PUBLICAT N: MONITORUL OFICIAL nr. 95 bis din 4 februarie 2011

"Ghid

-----------*) Aprobat de Ordinul nr. 1.454 din 30 noiembrie 2010, publicat n Monitorul
Oficial al Romniei, Partea I, nr. 95 din 4 februarie 2011.
UNIVERSITATEA DE MEDICIN I FARMACIE "CAROL DAVILA" BUCURETI
SPITALUL CLINIC UNIVERSITAR DE URGEN ELIAS
CLINICA UNIVERSITAR DE GERIATRIE
B-dul Mrti nr. 17, Sector 1, Bucureti
Tel/Fax: 0213107122
GHID PRACTIC DE UTILIZARE EVALUAREA GERIATRIC
Argumente, eficien, cuantificarea datelor evalurii,
formarea limbajului medical european i internaional
Conf. Univ. Dr. LUIZA SPIRU
Preedinte al Comisiei Naionale de Geriatrie
i Gerontologie Catedra de Geriatrie Gerontologie/
U.M.F. "Carol Davila" Bucureti
ef Clinica Universitar Geriatrie Gerontologie/
Spit. Univ. de Urg. Elias
ef Centrul de Diagnostic i Tratament
al Bolilor de Memorie
Coordonator pt Romnia al European Alzheimer's
Disease Consortium
Evaluarea geriatric (EG) este o abordare interdisciplinar care vizeaz
estimarea medical i psihosocial a pacientului, stabilirea unui diagnostic corect
i identificarea strategiilor adecvate pentru prevenie, tratament i reabilitare.
Astfel, eforturile i cheltuielile n domeniul ngrijirii medicale pot fi reduse,
iar sperana de via va crete.
EG include un istoric natural complex al fiecrui pacient, care include date
personale, detalii antropometrice, antecedente heredocolaterale, diagnosticri i
tratamentele anterioare i date referitoare la condiiile ambientale de via
(fumat, alcool, droguri, stress, mediu toxic, statutul social).
Este un proces multidimensional realizat pentru evaluare:
clinic,
funcional,
psihico-cognitiv,
mental,
paraclinic,
imagistic,
a persoanelor n vrst.
EG cuprinde scale de evaluare specifice grupelor de vrst, de peste 50 de ani,
care faciliteaz ntr-un timp eficient obinerea de informaii pentru stabilirea
unui DIAGNOSTIC CORECT DE VRST, n contextul polipatologiei pacientului.
S-a constatat c numeroase persoane vrstnice sufer de:
- probleme medicale,
- probleme mentale,
- probleme sociale complexe
EG vizeaz o instruire asupra concluziilor modificrilor medicale i
psihosociale ale persoanelor n vrst.
EG ncepe cu identificarea deteriorrii clinice i a factorilor de risc ai
acestei deteriorri. Deteriorarea clinic se refer la:
- agravarea unei boli

- nrutirea statuss-ului funcional

Profesionitii din snatate dezvolt strategii de:
- prevenire,
- tratare,
- reeducare
pentru
- ameliorarea capacitilor funcionale ale pacientului,
- pstrarea capacitilor funcionale ale pacientului,
- creterea speranei de via.
Evaluarea de Geriatrie-Gerontologie
ISTORIA NATURAL A PACIENTULUI- stabilit mpreun cu pacientul i familia
acestuia
EVALUAREA GERIATIC A PACIENTULUI
Realizarea unui istoric corect, elaborat, cu ajutorul pacientului i
aparintorului este cheia unui diagnostic corect i a prioritizrii reale a
diagnosticului final, n cadrul polipatologiei pacientului.
Istoricul natural este urmat de aplicarea unui set de scale de evaluare
specific pentru fiecare grup de vrst (ncepnd de la 50 de ani):
Mini-evaluare a strii mentale (MMSE), Folstein i Groupe de Recherche sur
les Evaluations Cognitives, Folstein-Greco (vezi ghid scale de evaluare i anexa 1)
Testul orologiului (CDT), H. Brodaty: care reflect funciile cortexului
frontal i temporo-parietal
Scorul activitilor cotidiene (ADL) i Scorul activitilor cotidiene ce
necesit folosirea instrumentelor (IADL), ambele n variant prescurtat: pentru
evaluarea independenei/dependenei pacientului;
Scala Depresiei Geriatrice Yesavage (GDS) forma prescurtat pentru detectarea
simptomelor depresive;
Evaluarea echilibrului static i dinamic (Tinetti): pentru diagnosticarea
bolilor neurodegenerative;
Mini-evaluarea nutritional (MNA), Guigoz Y, Vellas B and PJ Garry: pentru
evaluarea statutului nutriional al pacientului,
Scala Bedsore Norton pentru pacienii cu patologie sever
Analize paraclinice
Explorri funcionale
Investigaii imagistice
Teste pentru diagnostic diferenial
Scale de evaluare specific pentru pacienii cu patologie neurodegenerativ
Profilul psihologic
Evaluarea socio-economic a pacientului i a familiei acestuia.
Referine
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type: a comparison of three scoring methods in a memory disorders clinic.
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3. Burke WJ, Houston MJ, Boust SJ et al (1989) Use of the Geriatric Depression
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Scheltens Ph, Frolich L & Verhey FRJ; The prevalence and severity of
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R.W., Burns A., Bullock R., Malick A., Salmon E., Waldemar G., Dartigues J.F.,
Pasquier F., Touchon J., Robert Ph., Rigaud A.S., Camus V., Stiens G., Frolich L.,
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A., Aguera-Morales E., Ribera-Casado J.M., Lage P.M., Winblad B./ Eriksdotter
Jonhagen M., Michel J.P., Scheltens P., Olde-Rikkert M., The ICTUS Study: A
Prospective Longitudinal Observational Study of 1,380 AD Patients in Europe; Study
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cognitiv lejer (MCI), Brain Aging International Journal - editie in limba romana,
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32. Spiru L, Romosan I. Geriatrie, Vol. I, Editura Solness, Timioara, 2002
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34. Spiru L, Vellas B, Ousset PJ, Scorul activitilor vieii cotidiene, Brain
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Examination) i testul orologiului, Brain Aging International Journal - ediie n
limba romna, Vol. 1, Nr. 1, 2003
36. Spiru L, Vellas B, Ousset PJ,, Scorul IADL al activitilor curente, Brain
Aging International Journal - editie n limba romna, Vol. 2, Nr.1, 2004
37. Spiru L, Vellas B, Ousset PJ. Caiet de observaie pentru pacienii cu
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38. Spiru L, Vellas B, Ousset PJ. Caiet de observaie pentru pacienii cu
demen tip Alzheimer, Ediia II, Editura Universitar "Carol Davila", Bucureti,
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39. Spiru L, Vellas B, Ousset PJ. Teste clinice pentru diagnosticul demenei de
tip Alzheimer, Editura Universitar "Carol Davila", Bucureti, 2001
40. Spiru L., Vellas B., Ousset P.J., Effects of Hospitalization on Cognitive
Function, Activities of Daily Living Capacity and Behavior in Alzheimer's Disease
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Vol. 1, nr. 1/2002
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patients - a Romanian descriptive study, Neurobiology of Aging, ISSN: 0197- 4580,
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46. Tangalos EG, Smith GE, Ivnik RJ, et al. The Mini-Mental State Examination
in general medical practice: Clinical utility and acceptance. Mayo Clin Proc. 1996;
71:829-837.
47. Tsolaki M., Papaliagkas V., Jones R., Touchon J., Spiru L., Visser P. J.,
Verhey F., DESCRIPA Study Group; Medication in patients with mild cognitive

impairment in Europe: The development of screening guidelines and clinical criteria

of predementia Alzheimer's disease (DESCRIPA) study; Alzheimer's & Dementia: The
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48. Vellas B., Guigoz Y., Garry P., Nourhashemi F., Bennaoum D., Lauque S.,
Albarede J L.,: The mini nutritional assessment (MNA) and is use in grading the
nutritional state of elderly patients. Nutrition 99, 15:116-122
49. Vellas B., Standardized geriatric evaluation. An efficient method for the
prevention of dependency; Soins. Gerontologie 1996;(2):6.
50. Visser PJ, Verhey FR, Boada M, Bullock R, De Deyn PP, Frisoni GB, Frolich
L, Hampel H, Jolles J, Jones R, Minthon L, Nobili F, Olde Rikkert M, Ousset PJ,
Rigaud AS, Scheltens P, Soininen H, Spiru L, Touchon J, Tsolaki M, Vellas B,
Wahlund LO, Wilcock G, Winblad Development of screening guidelines and clinical
criteria
for
predementia
Alzheimer's
disease.
The
DESCRIPA
Study,
B.
Neuroepidemiology, ISSN: 0251-5350; 30(4):254-65; 2008
51. Visser P. J., Verhey F., Knol D., Scheltens P., Wahlund L., Freund-Levi Y.,
Tsolaki M., Minthon L., Wallin A., Hampel H., Buerger K., Pirttila T., Soininen H.,
Olde Rikkert M., Verbeek M., Spiru L., Blennow K., Prevalence and prognostic value
of cerebrospinal fluid markers of Alzheimer pathology in subjects with subjective
cognitive impairment and mild cognitive impairment. The DESCRIPA study. The Lancet
Neurology, ISSN: 1474-4422, 2009
52. Zarit SH, Orr NK, Zarit JM. The hidden victims of Alzheimer's disease;
families under stress. New York: New York University Press; 1985
53. Zarit SH, Reever KE, Bach-Peterson J. Relatives of impaired elderly:
correlates of feeling of burden. Gerontologist 1980; 20:649-55.
54. Visser PJ, Verhey F, Knol DL, L. Spiru et al., Prevalence and prognostic
value of CSF markers of Alzheimer's disease pathology in patients with subjective
cognitive impairment and mild cognitive impairment in the DESCRIPA study: a
prospective, case-control study. Lancet Neurol 2009; published online June 11.
DOI:10.1016/S1474-4422(09)70139-5.
55. J. Norberg, C. Graff, O. Almkvist, M. E. Ewers, G. B. Frisoni, L. Frolich,
H. Hampel, R. Jones, P. Kehoe, H. Lenoir, L. Minthon, F. Nobili, M. Olde Rikkert,
A.-S. Rigaud, Ph. Scheltens, H. Soininen, L. Spiru, M. Tsolaki, L.-O. Wahlund, B.
Vellas, G. Wilcock, F. Verhey, P. J. Visser, Regional effects of APOE epsilon 4 in
mild cognitive impairment and subjective cognitive impairment: Results from the
DESCRIPA study
56. A pilot, comparative epigenomic and metabolomic study in healthy elderly,
adult and young people, Cucu N., Anton G., Radu LG, Turcu I., Spiru L, in:
Collection of Selected Free Papers from the 9th International Conference on
Alzheimer's and Parkinson's Disease AD/PD, Prague, Czech Republic, March 11-15,
2009, Editors: Abraham Fisher and Israel Hanin, Medimond International, January
2010, pp. 83-89
57. Gender aspects in Mild cognitive Impairment (MCI) to Alzheimer's Disease
(AD) conversion. A Romanian epidemiological study, Spiru L., Ioancio I., Nuta C.,
Turcu I., in: Collection of Selected Free Papers from the 9th International
Conference on Alzheimer's and Parkinson's Disease AD/PD, January 2010, pp.59-65
58. Arguments for the reconsideration of procaine as a potent therapeutic
molecule in AD/PD, Turcu I., Spiru L., in: Collection of Selected Free Papers from
the 9th International Conference on Alzheimer's and Parkinson's Disease AD/PD,
Prague, Czech Republic, March 11-15, 2009, Editors: Abraham Fisher and Israel
Hanin, Medimond International, January 2010, pp.127-135
59. A pilot, comparative epigenomic and metabolomic study in healthy elderly,
adult and young people, Cucu N., Anton G., Radu LG, Turcu I., Spiru L, in:
Collection of Selected Free Papers from the 9th International Conference on
Alzheimer's and Parkinson's Disease AD/PD, Prague, Czech Republic, March 11-15,
2009, Editors: Abraham Fisher and Israel Hanin, Medimond International, January
2010, pp.83-89
60. Gender aspects in Mild cognitive Impairment (MCI) to Alzheimer's Disease
(AD) conversion. A Romanian epidemiological study, Spiru L., Ioancio I., Nuta C.,
Turcu I., in: Collection of Selected Free Papers from the 9th International
Conference on Alzheimer's and Parkinson's Disease AD/PD, January 2010, pp.59-65
61. Arguments for the reconsideration of procaine as a potent therapeutic
molecule in AD/PD, Turcu I., Spiru L., in: Collection of Selected Free Papers from
the 9th International Conference on Alzheimer's and Parkinson's Disease AD/PD,

Prague, Czech Republic, March 11-15, 2009, Editors: Abraham Fisher and Israel
Hanin, Medimond International, January 2010, pp.127-135
62. Visser PJ, Verhey F, Knol DL, L. Spiru et al., Prevalence and prognostic
value of CSF markers of Alzheimer's disease pathology in patients with subjective
cognitive impairment and mild cognitive impairment in the DESCRIPA study: a
prospective, case-control study. Lancet Neurol 2009; published online June 11.
DOI:10.1016/S1474-4422(09)70139-5.
63. J. Norberg, C. Graff, O. Almkvist, M. E. Ewers, G. B. Frisoni, L. Frolich,
H. Hampel, R. Jones, P. Kehoe, H. Lenoir, L. Minthon, F. Nobili, M. Olde Rikkert,
A.-S. Rigaud, Ph. Scheltens, H. Soininen, L. Spiru, M. Tsolaki, L.-O. Wahlund, B.
Vellas, G. Wilcock, F. Verhey, P. J. Visser, Regional effects of APOE epsilon 4 in
mild cognitive impairment and subjective cognitive impairment: Results from the
DESCRIPA study
ANEXA
la ghid
SPITALUL CLINIC DE URGEN ELIAS
SECIA CLINICA DE GERIATRIE, GERONTOLOGIE I PSIHOGERIATRIE
CORP D, ET. 3
CLINICA OTOPENI
*T*
Data..........................
ntocmit de...................

CNP ...........................
Nr. Fiei .....................
Grup sangvin.......... Rh......
ALERGIC LA.....................

FOAIE DE OBSERVAIE GERIATRIC

Nume

:___________________________Prenume:____________________Vrsta :______

Data naterii: anul________luna___________ziua_________Sex_____________

Domiciliul: Judeul_________________ Localitatea______________sect_____
Strada_____________________________Nr______Ap_______Sc______Bl_________
Talon de pensie/Nr. Comanda _________________Ocupaia(avuta)___________
Starea civil____________Buletin de ident./Paaport seria_______nr_____

Data internrii
anul..........luna..........ziua...........ora.......
Data externrii
anul..........luna..........ziua...........ora.......
Numar zile de spitalizare............
Numar zile concediu medical acordate la externare...................
Diagnosticul de trimitere
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Diagnostic la internare
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Diagnostic la 72 de ore
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Diagnostic la externare

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Diagnostic gerontologic
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Antecedente personale fiziologice
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Antecedente personale patologice
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Antecedente heredo-colaterale
Vrsta
Cauza deces
1. Mama ______________________
________
____________________
2. Tata ______________________
________
____________________
3. Bunica m___________________
________
____________________
4. Bunic m ___________________
________
____________________
5. Bunica p___________________
________
____________________
6. Bunic p ___________________
________
____________________

Starea fizic
Mobilitate____________ autoservire_____________capacit. munc_____________
nalime____________ Greutate_____________tip alimentar_____________
Factori de risc
fumat________________
alcool__________
noxe____________
MOTIVELE INTERNRII:
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ISTORICUL BOLII:
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MOD DE VIA

DOMICILIAZ SINGUR

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DOMICILIAZ CU SOUL-SOIA

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DOMICILIAZ CU FAMILIA

[]

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AZIL DE BTRNI

[]

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INTERNARI PRELUNGITE

[]

[]

ALTELE...............................

[]

[]

Examen clinic obiectiv

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Examen clinic obiectiv
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*ST*

Testul MMSE (Mini Mental State Examination)

Durata testului: 10 minute.
Interpretare: de ctre examinator (n acest sens, este necesar o pregtire de
specialitate).
Indicaii principale: evaluarea funciei cognitive.
Acordai cte un punct pentru fiecare rpuns corect. Scorul maxim posibil este
de 30.
"Am s v pun cteva ntrebri pentru a aprecia cum funcioneaz memoria
dumneavoastr. Unele sunt foarte simple, altele mai puin. ncercati s rspundeti
ct de bine putei."
Orientare
n ce dat suntem astzi?
Dac rspunsul este incorect sau incomplet punei ntrebrile de mai jos n
ordinea specificat:
1) n ce an suntem?
[]
2) n ce anotimp?
[]
3) n ce lun?
[]
4) n ce dat?
[]
5) n ce zi a sptmnii suntem?
[]
"Acum vreau sa v pun cteva ntrebri despre locul n care ne aflm:"
6) Care este numele spitalului? care v aflai (sau adresa medicului)? []
7) n ce or ne aflm?
[]
8) Care este numele judeului? care este acest ora?
[]
9) n ce regiune suntem?
[]
10) La ce etaj ne aflm?
[]
Memorie imediat
ntrebai pacientul dac v permite s-i testai memoria. Apoi rostii tare i
clar numele a trei obiecte, fr vreo legatur ntre ele, cu pauze de cte o
secund ntre ele. Cerei pacientului s le repete pe toate trei. Notai cu 1 punct
fiecare cuvnt corect repetat; scorul se calculeaz n funcie de prima ncercare
de a le repeta (0-3), dar dac nu reuete de prima dat, reluai testarea pn
cnd pacientul repet toate trei cuvintele (ncercai de maxim 5 ori). Dac

pacientul nu le poate nva pe toate, memoria imediat nu poate fi evaluat

corespunzator. "Am s v spun trei cuvinte. A dori s mi le repetai i s
ncercai s le reinei deoarece v voi cere n curnd s mi le spunei din nou:"
11) igara
[]
12) Floare
[]
13) Ua
[]
Atenie i calcul mental
Pacientul trebuie s scad din 7 n 7 pornind de la 100 i s se opreasc dupa
5 scderi. Notai cu 1 punct fiecare scdere corect dac greete ntrebai
"suntei sigur?", iar dac rspunsul este corect acordai punctul:
14) 100 - 7
[]
15) 93 - 7
[]
16) 86 - 7
[]
17) 79 - 7
[]
18) 72 - 7
[]
Alternativ: dac pacientul nu poate ndeplini testul anterior, cerei-i s
rosteasc invers cuvtul "avion": A_V_I_O_N. Scorul corespunde numrului de litere
aflate n poziie corect. n scorul total MMSE va fi inclus rezultatul doar unuia
dintre cele dou teste alternative.
Memorie pe termen scurt
"V amintii cele trei cuvinte pe care le-ai repetat puin mai devreme?"
Notai cu 1 punct fiecare cuvnt repetat:
19) igara
[]
20) Floare
[]
21) Ua
[]
Limbaj
Notai cu un punct fiecare rspuns corect:
Denumire:
22) Artai pacientului un creion.
Ce reprezint acest obiect ?
[]
23) Aratai pacientului un ceas.
Ce reprezint acest obiect ?
[]
Repetare: cerei pacientului s repete o propoziie dup dumneavoastr.
24) Repetai "nu exist dac nu exist dar". []
nelegerea unei comenzi: cerei pacientului executarea unei comenzi triple.
Notai cu un punct executarea corect a fiecrei comenzi n parte.
25) Luai aceast foaie de hrtie n mna dreapt,
26) ndoii-o n doua i
[]
27) Aruncai-o jos.
[]
Citire: artai pacientului o foaie de hrtie pe care scriei cu litere mari
"nchidei ochii". Cerei-i s citeasc i s fac ceea ce este scris pe foaie.
Notai cu un punct executarea corect a ordinului.
28) Facei ceea ce scrie pe aceeast foaie. []
Scriere: cerei pacientului s scrie o propoziie. Nu-i dictai propoziia,
pacientul trebuie s o scrie spontan. Notai cu 1 punct o propoziie care conine
un predicat i un subiect, corect din punct de vedere semantic, indiferent de
gramatic sau ortografie.
29) Scriei-mi o propozitie, ceea ce vrei, dar s fie o propoziie ntreag []
Copiere: artai pacientului o foaie de hrtie pe care sunt desenate dou
pentagoane care se intersecteaz, fiecare avnd laturile de aproximativ 2,5 cm i
ntrebai-l: "Putei reproduce acest desen?" Notai cu 1 punct dac toate cele 10
unghiuri sunt reprezentate i cele dou figuri se intersecteaz corect.
Tremurturile i rotaia figurilor vor fi ignorate.
30) Copiai acest desen pe aceast foaie
[]
NOT(CTCE)
----------------Reprezentarea desenului se gsete n Monitorul Oficial al Romniei, Partea I,
nr. 95 din 4 februarie 2011, la pag. 87 (a se vedea imaginea asociat).
Scor total

[]

Activiti ale vieii cotidiene (ADL, IADL)

*T*
Activities of Daily Living (ADL) ADL Instrumental
[] Igiena corporala
[] Capacitatea de folosire a telefonului
[] mbracare
[] Face cumprturi
[] Mersul la toaleta
[] Prepararea alimentelor
[] Locomoia
[] Menajul
[] Continena
[] Splatul rufelor
[] Odihna / Repaus
[] Utilizarea mijloacelor de transport
[] Responsabilitate n urmarea tratamentului
[] Capacitate de a folosi bani
Scor ADL: [] /6

Scor IADL: [] /8

*ST*
Scara Depresiei Geriatrice Yesavage
(GDS) versiune prescurtat
*T*
DA
NU

1.Suntei mulumit(a) de viaa dvs.?

2.Ai renunat la mare parte din activitile dvs?

3.Avei sentimentul ca viaa dvs. este goal?

4.V plictisii des?

5.Suntei bine dispus n general?

6.V temei c vi se poate ntmpla ceva ru?

7.Suntei n general fericit?

8.Avei sentimentul c suntei de acum fragil?

9.Preferai s ramnei singur n camer mai degrab dect s

iesii?

10.Credei c memoria dvs. este mai slab dect a majoritii

oamenilor?

11.Credei c este minunat c traii n aceast epoc?

12.V simii actualmente o persoan lipsit de valoare?

13.Avei mult energie?

14.Credei c situaia dvs. actual este disperat?

15.Credei c situaia altora este mai bun dect a

dumneavoastr?

Scor [] /15 "deprimat(a)" daca raspunde:

NU la 1, 5, 7, 11, 13

DA la restul

*ST*

Normal......................3 +/- 2
Oarecum deprimat(a).........7 +/- 3
Foarte deprimat(a).........12 +/- 3

Evaluarea echilibrului static i dinamic n timpul mersului: Proba Tinetti

1. Evaluarea echilibrului static

(Incercuii varianta corespunzatoare de echilibru pe fiecare item i apoi
facei totalul punctelor ncercuite)
*T*
Normal Adaptat Anormal

1.Echilibru n poziie aezat

1
2
3

2.Ridicarea de pe scaun

1
2
3

3.Echilibru imediat dup ce s-a ridicat

1
2
3

4.Echilibru n picioare

1
2
3

5.Echilibru n picioare cu ochii inchii

1
2
3

6.Echilibru dup o rotaie complet de 360

1
2
3

7.Rezistena la apsarea sternal

1
2
3

8.Echilibru dup rotirea capului

1
2
3

9.Echilibru n poziie unipodal

1
2
3

10.Echilibru cu ntinderea zonei cervicale a coloanei

1
2
3

11.Echilibru cu ntinderea zonei cervicale a coloanei

1
2
3

i ridicarea membrelor superioare

12.Echilibru n poziie aplecat n fa

1
2
3

13.Echilibru aezndu-se

1
2
3

Scor normal = 13
*ST*
2. Evaluarea echilibrului dinamic n timpul mersului
(ncercuii varianta corespunztoare de echilibru pe fiecare item i apoi
facei totalul punctelor ncercuite)
*T*
Normal Anormal

1.Echilibru la nceputul mersului

2.nlimea pasului

3.Lungimea pasului

4.Simetria pasului

5.Continuitatea mersului

6.Devierea de la traiectorie

7.Stabilitatea corpului

8.ntoarcerea n timpul mersului

Scor normal = 8
*ST*
Scorul Hatchinski:
*T*


n caz de
CotaiaScorul pacientului

Debut brusc

[]

Deteriorare n trepte

[]

Evoluie fluctuant

[]

Confuzie nocturn

[]

Conservarea relativ a personalitii

[]

Depresie

[]

Manifestri somatice

[]

Labilitate emoional

[]

Hipertensiune arterial

[]

Antecedente sau accidente vasculare cerebrale

[]

Evidene de ateroscleroz asociat

[]

Simptome neurologice de focar

[]

Semne neurologice de focar

[]

Scor total: []
Punctaj: 0-4 = boala Alzheimer

5-6 = boala mixt Alzheimer

i vascular

7 = demen
multiinfarct

*ST*
Evaluarea strii nutriionale - Mini Nutritional Assessment "MNA"
I. Indici antropometrici
*T*
*Font 9*
1. Indici ai mesei corporale (IMC = Greutate / (nlime) n kg/m
0 = IMC <19
1 = 19 IMC < 21
2 = 21 imc < 23
3 = IMC 23
Scor
____
2. Circumferina brachial (CM in cm)
0,0 = CB < 21
0,5 = 21 CB 22 1,0 = CB > 22
Scor
____
3. Circumferina gambei (CM in cm)
0 = CM < 31
1 = CM 31
Scor
____
4. Pierderea recent n greutate (<3 luni)
0 = scdere > 3 kg
1 = nu tie
2 = scdere n
3 = nu a pierdut n
greutate
n greutate
greutate
ntre 1 i
3 kg
Scor
____
*ST*
II. Evaluare gobal
*T*
*Font 9*
5. Pacientul triete independent la domiciliu?
0
=
nu
1
=
da
Scor____

6. Ia mai mult de 3 medicamente?

0
=
da
1
=
nu
Scor____
7. Boli acute sau stress psihic n ultimele 3 luni?
0
=
da
1
=
nu
Scor____
8. Motricitate
0 = din pat
1 = autonomie la interior
2 = iese din domiciliu
Scor____
la fotoliu
9. Probleme neuropsihologice
0 = demen sau
1 = demen sau depresie
2 = nu are probleme
psihologice
depresie sever
moderat
Scor
____
10. Escara sau plgi cutanate
0
=
da
1
=
nu
Scor____
11. Indici dietetici
Cte mese adevrate servete pacientul pe zi?
(dejun, prnz, cin cu mai mult de 2 feluri de mncare)
0 = 1 masa
1 = 2 mese
2 = 3 mese
Scor____
12. Consum?
Cel puin o dat pe zi produse lactate
Da Nu
Cel puin o dat pe sptmn ou sau legume
Da Nu
n fiecare zi pete, carne de vit sau de pasre
Da Nu
0,0 = dac 0 sau 1
0,6 = dac 2
1,0 = dac 3
Scor____
12. Consum de cel puin 2 ori pe zi fructe sau legume?
0
=
nu
1
da
Scor____
13. Prezint o scdere a apetitului? A mncat mai puin n ultimele luni din
cauza
scderii poftei de mncare, problemelor digestive, dificultilor de masticaie
sau
deglutiie?
0 = anorexie
1 = anorexie moderat
2 = nu are anorexie
Scor____
14. Cte pahare de lichide consum zilnic? (ap, sucuri, cafea, ceai, vin,
bere...)
0,0 = mai puin
0,6 = ntre 3 i
1,0 = mai mult de 5 pahare
Scor____
de 3 pahare
5 pahare
15. Mod de a se hrni
0 = necesit
1 = se hrnete
2 = se hrnete singur
Scor____
asisten
singur, dar
fr dificultate
cu dificultate
*ST*
III. Evaluare subiectiv
*T*
*Font 9*
16. Pacientul se consider bine hrnit ? (probleme nutriionale)
0 = malnutriie
1 = nu tie sau
2 = fr probleme de nutriie
Scor____
sever
malnutriie
moderat
17. Pacientul consider starea sntii sale mai bun sau mai proast dect a
majoritii persoanelor de aceeai vrst?

0,0 = mai proast

0,5 = nu tie

1,0 = la fel 2,0 = mai bun

Scor____
TOTAL
Scor____/30

Puncte: stare nutriional satisfctoare

< 17 puncte: stare nutriional
proast
de
la
17
la
23,5
puncte:
risc
de
malnutriie

*ST*
Examene paraclinice i interdisciplinare
*T*

DATA
EXAMENE IMAGISTIC

EKG

EEG

OSCILOMETRIE

EXPLORRI FUNCIONALE RESPIRATORII

Examene de laborator

Nr

crt.

1 Hemoleucograma

*Hematocrit

*Hemoglobina

*Leucocite

*Limfocite

2 VSH

1 h

2h

3 Test Quick de protrombina

4 Test Howell

5 Glicemia

6 LDL

7 HDL

8 Colesterol

9 Trigliceride

10 Proteine totale

11 Proteinograma

Albumine

*globuline1

globuline2

globuline

globuline

total globuline

raport A/G

raport/

12 Thymol

13 Uree

14 Ac Uric

15 Creatinin

 16 Calciu

17 Ionograma serica

18 Bilirubinemia

19 Fosfataza acid

20 Fosfataza alcalin

21 Transaminaze:

*T.G.O

*T.P.O

*G.G.T

22 Ex. urin

*ph

*densitate

*sediment

23 Examen urocultur

28.*Nr.Serii Gerovital H3Fiole

T *Nr Serii Gerovital H3,drajeuri

R *Nr.Serii Aslavital,fiole

*ST*
Examinare psihologic
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Examinare psihologic
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Consult kinetoterapie
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