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

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

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. ADD PICTURE TO THIS SLIDE What are plaque and tangles??????????????????????????????????????????????????????????? explain

Healthy Brain vs. Advanced Alzheimer’s

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

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

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

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 Dementia of the Alzheimer's type accounts for 50-70% of all cases of dementia

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

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

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

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

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 Clinical management also goes along with periodontal management.

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

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 Porphyromonas gingivalis (P. gingivalis) Immune system response Evidence does suggest an association between Alzheimer’s disease and poor oral health

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 acytocholine levels 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.

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

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

Questions?

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