5. Alzheimer's and Parkinson's Disease Flashcards
Aging increases the risk of what other changes
- Cognitive loss (not dementia)
- Syncope (baroreceptors fail)
- Glaucoma
- Impaired vision in dark and glare
- Cataracts
- Hearing loss for pure tones (esp higher frequencies)
- 5-7% decrease in brain weight
- Significant decrease occurs in blood flow to brain
- Decreased baroreflex sensitivity
- Increased rigidity of the iris and decreased elasticity of the lens
- Loss of cochlear neurons
Define delirium
impairment of attention and conciousness
Delirium is (temporary/permenant)
temporary (or transient)
Delirium is ususally assoc. with underlying medical disorder such as
Electrolyte imbalance
T/F Dementia is a disease
f it is a syndrom or a constellation of syndroms
Characteristics of dementia are
- Decline in memory
- Intellect
- Personality
What is the most common cause of dementia
Alzheimer’s
List some of the different types of dementia
-Alzheimer’s
-Mixed dementia
-Lewy Body dementia
-Parkinson’s dementia
-
Describe lewy body denentia
- Neurodegenerative disorder associated with abnormal structures found in the brain (Lewy bodied)
- Clumps of cells with cellular inclusions containing alpha- synuclein
Symptoms of Lewy Body dementia
- Fluctuating altertness and or cognition
- Recurrent visual hallucinations
- Parkinson’s symtoms
What is the most common form of dementia
Alzheimer’s
Alzheimers involves parts of the brain that control
- though
- memory
- language
Brain changes that occur in Alzheimer’s
- Amyloid plaques
- Tangled bundles of fibers (neurofibrillary tangles)
- Dead brain cells
- Disrupted connections between brain cells
- Lower levels of neurotransmitter
What are the theories of causation for alzhiemers
- Amyloid hypothesis
- Tau hypothesis
- Inflammation
- Free radicals
- Cholinergic hypothesis
- Type III diabetes
- Infection
Describe the infection hypothesis
Miklossy- Studied determined people with Alzhiemer’s had larger conc. of oral spirochetes in their brains
Describe the inflammation hypothesis
- IL-1 is critical to processing APP
- IL-6 and TNF-alpha trigger amyloid deposition
Why has the death toll for alzheimers increased throughout the years while all other diseases have declined
there are more old people and because we don’t know much about how to cure it
Alzhiemer’s disease is characterized by
brain cortex atrophy
-Deficiency of acetylcholine and associated enzymes
What are the three stages of Alzheimer’s
- Early
- Moderate
- Advanced
Describe Early Alzheimer’s
- Memory loss
- Confusion about location of familiar places
- Issue accomplishing daily tasks
- Trouble paying bills
- Poor judgmenet leading to poor decisions
- Loss of spontaneity and sense of initiative
- Mood and personality changes increased anxiety
Describe moderate Alzheimers
- Restlessness, agitation, anxiety, tearfulness, wandering esp in later afternoon or at night
- Repetitive statements or movement occasional muscle twitches
- Hallucinations, delusions, suspicious or paranoia irritability
- Loss of impulse control (shown through sloppy table manners, undressing at inappropriate times, vulgar language)
- Perceptual- motor problems (such as trouble getting out of a chair or setting the table)
Describe advanced Alzheimer’s
- Weight loss
- Seizures, skin infections, difficulty swallowing
- Groaning, moaning or grunting
- Increased sleeping
- Lack of bladder and bowel control
What pharmacologic class of drug is commonly used to treat alzheimer’s
acetylcholinesterase inhibitors
What is one of the most common drugs used to treat alzheimer[s
denepezil
What is one drug commonly used to treat alzheimers (out of the 5 approved) that is not an acetylcholinesterase inhibitor
memantine
What is the pharmacologic class of memantine
glutamate receptor antagonist
Describe the Mini Mental State Exam (MMSE)
11-question measure that tests 5 areas of cognitive function
- Orientation
- Registration
- Attention
- Calculation
- Recall
- Language
Max score on the MMSE
30
A score lower than _ on the MMSE indicates cognitive impairment
23
Describe the mini cog test
- Tell the patient 3 words
- Ask them to repeat the words
- Write a clock
- Repeat the words
People that take meds for dementia should use what preventative measures to protect against caries
- Fluoride varnish and chlorhexidine
- Frequent recalls
Tx planning someone with early dementia
- Anticipate oral decline
- Eliminate potential sources of pain and pathology and infection asap
- Aggressive elimination of potential problems
Tx plan for moderate dementia
-Expect uncooperative behavior
-Short appointments
-Silver Diamine fluoride
0OH is totally the caregiver’s responsibility
-Minimal changes due to inability of patient to adapt
Tx plan with late demential
- Avoid complex treatment
- Consider IV sedation or general
- Focus on removing unrestorable teeth and oral hygiene
Parkinson’s diseases is characterized by
motor symptoms
- Tremors
- Rigidity
- Muscle weakness
- Peculiar gait
Non-motor symptoms
- Autonomic dysfunction
- Variation in BP
- Cardia dysrhythmias
- Excessive sweating
- Bladder/bowel dysfunction
Behavioral symptoms
- Depression
- Cognitive impairment
- Dementia
Most likely etiology of parkinson’s diseases
- Relative excess of Acetylcholine**
- Irreversible loss of dopaminergic neurons of basal ganglia
- Dopamine inhibits excitatory action of acetylecholine and controls extrapyramidals motor system
- Severity related to extent of dopamine deficiency
Oral symptoms of Parkinson’s
- Excessive salivation (due to esophageal dysmotility and dysphagia)
- Angular cheilitis common
- Loss of facial expression
- Difficulty with mastication
- Slow speech
- Tremors of head lips and tongue
- Tardive dyskinesia (lip smacking, grimacing, tongue flittering)
What is tardive dyskinesia
involuntary orofacial movements from long term levodopa use
What are the contraindications to routine dentistry for parkinson’s patients
none
is premed required for parkinson’s patients
no
Parkinson’s dental issues
- levodopa may cause sailvary dysfunction
- Excessive salivation may interfere with tx
- Frequent recall
- Early interventions
- Treatment based on pateints abilities
- Tardive dyskinesia may necessitate mouthguard or enameloplasty to protect the tongue
- Pre-treatment with anxiolytic agents may be helpful
- Physical assistance due to uncontrolled movement
Challenges to dentist with parkinson’s patient
- When to intervene when pt can’t report symptoms
- How to determine if sensory perception is impaired
- How to predict what may become symptomatic later
Unreported oral discomfort may manifest as
- Increased restlessness
- Impaired sleep
- Moaning or shouting
- Refusal to eat favorite foods
- Refusal to cooperate
- Aggressive behavior
