By: Kim Le, Courtney Campbell, Ashlyn Bruno

Alzheimer’s disease is a progressive irreversible brain disorder characterized by intellectual and cognitive disturbance, behavioral changes, and eventually a state of complete dependence Alzheimer's the most common form of dementia Accounts for 60-80% of all dementia cases Dementia is the general term for a decline in mental ability severe enough to interfere with daily life

Etiology: UNKNOWN could be affected by genetics, environment, nutrition, free radicals, and infectious agents Average duration is 8 to 10 years from onset of symptoms to death Alzheimer’s is not a normal part of aging however greatest risk factor is increasing age

Alzheimer's affects There are 2 types: Early onset: very rare seen in patients in the 30s and 40s Late onset: most common, seen in patients over 65 Population Older Latinos are about one and a half times as likely as older whites to have Alzheimer's. Older African Americans are about twice as likely to have Alzheimer's than older whites.

1. No impairment (normal function): person does not experience any memory problems 2. Very mild cognitive decline (may be normal age related changes in memory or early stages of Alzheimer's disease: forgetting familiar words or the location of everyday objects Person may feel as if he or she is having memory lapses No symptoms of dementia can be detected during a medical examination 3. Mild cognitive decline (early stage of Alzheimer's can be diagnosed in some but not all): Friends, Family, or co-workers begin to notice difficulties Doctors may be able to detect problems in memory or concentration Common stage 3 difficulties include: Noticeable problems coming up with the right word or name Trouble remembering names when introduced to new people Having difficulty performing task in social or work settings Losing or misplacing valuable objects Increasing trouble with planning or organizing

4. Moderate cognitive decline (mild or early stage Alzheimer's disease) Forgetfulness of recent events Impaired ability to perform challenging mental arithmetic Greater difficulty performing complex tasks such as planning dinner Forgetfulness of ones own personal history Becoming moody or withdrawn 5. Moderately severe cognitive decline (moderate of mid-stage Alzheimers disease) Gaps in memory and thinking are noticeable Needs help in day to day activities Be unable to recall phone number, address, or what school they attended Need help choosing proper clothes for the season Can eat or use bathroom independently

7. Very severe cognitive decline (severe or late stage Alzheimer's disease) Loose ability to respond to their environment, carry conversation and eventually cant control movement Need help with personal care Muscles grow rigid and swallowing impaired 6. Severe cognitive decline (moderately severe or mid stage Alzheimer's disease) Difficulty of personal history Know own name Trouble remembering caregiver or spouse name Need help dressing properly Frequent problem controlling bladder or bowels Experience major changes in sleep patterns Experience major personality and behavioral changes

No proven treatment to prevent or cure. Medications slow the progression of the disease and temporarily improve cognitive function. Medications used for mild to moderate symptoms: Cholinesterase inhibitors Medications to address behavioral problems: Anti-depressants, anti-anxiety, and anti-psychotics Anti-convulsants, if seizures are present

Consider shorter appointments No contraindications for ultrasonic Use the Show-tell-do with the patient Chair position should be semi-supine, older patients may need cushion Fluoride and antimicrobials are contraindicated

Assessment Consideration Oral complications from medications Incontinence Fatigue from altered sleep patterns Disoriented/Confused Not capable of personal daily care Lose verbal abilities with increased sensitivity to nonverbal messages Increased numbers of plaques

Composition of the brain differs from the normal brain; areas of the brain are atrophied and ventricles enlarged; cells that produce acetylcholine are affected with resulting lower acetylcholine levels.

Preserve oral health and function Provide comfort, prevent disease Care Plan Directed at the stage of the disease. Provide comprehensive care in anticipation of future decline in oral health. Undiagnosed patients: referral to primary physician when patients behavior is suspected

Early Stages Review of patients M/D history at each maintenance appointment may reveal lapses in memory and other signs of early disease An early sign may be a slow decline of interest in oral hygiene and personal care Provide routine care with initiation of aggressive preventive regimens At onset of symptoms of disease, patient should be put on 3 month recall Fluoride use at home should be recommended along with fluoride varnish in office Involve caregivers when giving at home oral hygiene instructions DENTAL CONSIDERATIONS

Late Stages Routine intraoral examination to assess lesions due to cancer, medications, or injury Sedation may be required Possible need for mouth prop and physical restraints Power toothbrushes may improve dental biofilm removal Caregivers assume daily oral care Patient may reside in a long term facility, dental hygienists who specialize in the treatment of this population may oversee primary oral care

Brush teeth twice a day Floss teeth once a day Clean mouth and dentures after every meal Visually inspect the patient’s teeth and gums once a month Schedule regular dentist visits

A. Disorientation and mood swings B. The length of the appointment C. Communication difficulty D. Motor problems E. All the above

A. Question the patient about the symptoms B. Refer the patient to their primary physician C. Call the patients family D. Wait till the patient comes back for treatment to see if the symptoms have progressed

Which of the following is a treatment consideration for a patient with Alzheimer's? A.Premedicate B.Do not provide oral health education C.Schedule long appointments to avoid number of visits D.Schedule short appointments due to problems with cooperation.

A. Sexually transmitted disease B. Heart disease C. Progressive, irreversible brain disorder D. Parkinson’s disease

Alzheimer disease is a progressive brain disorder that gradually causes memory changes and the ability to reason. New medications are reserving these effects by removing beta-amyloid plaques in the brain. A. Both statements are true B. Both statements are false C. The first statement is true, and the second statement is false D. The first statement is false, and the second statement is true

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