Alzheimer’s Disease

1. Alzheimer’s Disease Erin Blackshear Amber Burks Danielle Chelette

2. Alzheimer’s Disease • A form of irreversible dementia, usually occurring in older adulthood, characterized by gradual deterioration of memory, disorientation, and other features of dementia. • Most common form of dementia • Progressive brain disorder • Patients lose verbal abilities with increased sensitivity to nonverbal messages

3. Alzheimer’s Disease (con’t) • A patient with Alzheimer’s disease, exhibits areas of the brain that are atrophied with enlarged ventricles and spaces • Cells that make acytocholine are altered resulting in lowered levels of acytocholine and increased levels of plaque and tangles • Acytocholine is a neurotransmitter correlated with memory.

4. Healthy Brain vs. Advanced Alzheimer’s

5. Stages of Alzheimer’s Disease • Stage 1- no impairment (no impairment) • Stage 2- very mild cognitive decline • Stage 3- mild cognitive decline • Stage 4- moderate cognitive decline • Stage 5- moderately severe cognitive decline • Stage 6- severe cognitive decline • Stage 7- very severe cognitive

6. Primary Etiology • Etiology is unknown, however a few ideas include: • Genetics • Environment • Nutrition • Free radicals • Infectious agents • Can be a combination of different factors

7. Secondary Etiology • Secondary inflammatory response may be due to one of the primary etiologic factors • Could be beneficial or harmful • Most often more damaging to the body than primary etiology

8. Occurrence • Two types • Early onset-rare, most common in ages 30s to 40s • Late onset-most common, people over 65 • More prevalent in the aging population as people are living longer, increasing the number of cases • 4.5 million Americans affected in 2007 • Occurrence doubles every 5 years beyond age 65

9. Treatment of Condition • No proven treatment or cure • NSAIDs may prevent the patient from developing this disease • Drugs are used to slow down the progression of disease • Treatment is mostly intended for support of the family and the patient

10. Medications • Mild to moderate symptoms • Cholinesterase inhibitors • Donepezil hydrochloride (Aricept) • Rivastigmine (Exelon) • Galantamine (Reminyl) • Medications for behavioral problems • Antidepressants • Antianxiety • Antipsychotics

11. Effects of Medications on Oral Health • Taste loss (Rivastigmine) • Tooth pain (Donepezil) • Hypotension • Hypertension • Syncope • Increased bleeding • Poor healing • Increased risk of infection

12. Indication • Lack of patient compliance (neglect) • Contraindication • Ultrasonic • Wilkins vs. Boards Review Book 2011-2012

13. Clinical Management • Caregiver must be present and understand informed consent • Caregiver needs to be educated on proper homecare procedures for patient • Assess need for power toothbrush • Encourage daily plaque control • Always monitor vitals • Consider semi supine chair position depending on severity and symptoms

14. Dental Treatment • No pre-med needed unless other condition are present • Patient positioning not specified, dependent on patient preference and severity of disease • Short morning appointments • Three month recall recommended • Not capable of personal daily care

15. Does poor dental health lead to Alzheimer’s disease? • The University of Central Lancashire (UCLan) School of Medicine and Dentistry • Donated brain samples • Ten patients without dementia • Ten patients suffering with dementia • Porphyromonasgingivalis (P. gingivalis) • Immune system response • Evidence does suggest an association between Alzheimer’s disease and poor oral health

16. Question #1 In a patient with Alzheimer’s disease areas of the brain are atrophied with enlarged ventricles and spaces between areas of the brain. Cells that produce acytocholine are affected with resulting decrease in acytocholinelevels and increased plaque and tangles. • The first statement is true, the second statement is true. • The first statement is true, the second statement is false. • The first statement is false, the second statement is true. • The first statement is false, the second statement is false.

17. Question #2 Which of the following is a treatment consideration for a patient with Alzheimer’s? A. Premedication B. Do not provide oral health education C. Schedule long appointments to eliminate number of visits D. Schedule short appointments due to problems with cooperation

18. Question #3 • When treating a patient with Alheizmer’s disease, which of the following should be considered • A. Disorientation and mood swings • B. The length of the appointment • C. Communication difficulty • D. Motor problems • E. A and C only • F. A, B, C, and D

19. Questions?

20. References • Wilkins, E. (2013). Clinical practice of the dental hygienist. (11th ed., pp. 798, 802-803 ). Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer Business. • Rogers, J., (2009). The inflammatory response in alzheimer's disease. J Periodontal , 79, 1535-1543. http://www.joponline.org.libproxy.lamar.edu/doi/pdf/10.1902/jop.2008.080171. • Crean S.J., Curtis, M.A., Kesavalu, L., Poole, S., Singhrao, S.K. (2013) . Poor dental health may lead to alzheimer’s. Journal of Alzheimer’s Disease, 1-2. http://www.j-alz.com/node/304 • Porth, C.M., (2007). Essentials of pathophysiology concepts of altered health states. (2nd ed., pp. 854-856). Philadelphia: Lippincott Williams & Wilkins. • Healthy Brain Vs. Alzheimer’s Brain. Retrieved December 2, 2013, from http://www.alz.org/braintour/healthy_vs_alzheimers.asp • Home Remedies Alzheimers Disease. Retrieved December 2, 2013, from http://www.homemademedicine.com/home-remedies-alzheimers-disease.html