SPECIAL CARE dementia Flashcards
what is dementia?
general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life
what are dementia risk factors?
age
female>male
ethnicity
down syndrome
medical factors
lifestyle factors
head injuries
what are the medical risk factors for dementia?
type 2 diabetes
hypertension
high cholesterol
obesity
depression
what are the lifestyle risk factors for dementia?
physical inactivity
smoking
unhealthy diet
excessive alcohol
what type of dementia does head injuries from sports cause?
chronic traumatic encephalopathy
what are the types of dementia?
alzheimer’s disease
vascular
mixed
lewy-body
fronto-temporal
what does alzheimer’s disease present with?
short-term memory loss and word finding difficulties
with progression there is more confusion
may experience mood swings and frustration and become more withdrawn
what is the biology behind alzheimers disease?
amyloid plaques
loss of connection between neurons
decrease in acetylcholine
what infections are associated with alzheimers?
oral herpes
pneumonia
spirochete bacteria
what is the association between perio disease and alzheimers?
gingivitis more common
proteins produced by p.gingivalis are present at higher conc in the brain
what causes vascular dementia?
reduced blood flow to the brain
often due to a stroke, or a series of transient ischaemic attacks
describe the deterioration of vascular dementia?
step-wise and linked to cerebrovascular changes in the brain
what may vascular dementia look like on an MRI?
white areas where infarcts have been
what is mixed dementia?
combination of alzheimers and vascular dementia
what causes lewy-body dementia?
lewy bodies (protein deposits) in nerve cells
what are symptoms of lewy-body dementia?
problems with thinking, movement, behaviour and mood
unpredictable changes in attention and alertness
visual hallucinations
disturbed sleep
what disease is lewy-body dementia associated with?
parkinsons
who does fronto-temporal dementia affect?
slightly younger
what are symptoms of fronto-temporal dementia?
early features - personality change
can exhibit challenging behaviour as disinhibition
may have short temper, aggression, mood swings and sexually inappropriate behaviour
how is dementia diagnosed?
personal and medical history
physical exam
bloods, urine, ECG
mental abilities checked
confirmed through CT/MRI, perfusion scan
what are the questionnaires used for dementia pts?
MMSE - mini mental state exam
AMTS
6 - CIT
GPCOG
7 minute screen
is there a cure for dementia?
no
what is the general treatment for dementia?
talking therapies
reduce cardiac risk (halt deterioration of vascular types)
NSAIDs may slow progression
drug tx for alzheimers
what are the 4 licensed drugs for alzheimers and parkinsons dementia?
donepezil
galantamine
rivastigmine
memantine
how does memantine treat alzheimers?
it treats memory loss in alzheimers and lewy body dementia
what is the new drugs approved in the UK to slow progression of alzheimers?
lecanemab
describe the early stage of dementia?
changes in ability and behaviour minor
misattributed to stress, bereavement or normal ageing
loss of short-term memory
confusion, poor judgment, unwilling to make decisions
anxiety, agitation, inability to manage everyday tasks
communication problems
how may early stages of dementia be noticed by the dental team?
forgotten appts
difficulty making decisions
deterioration in OH
forgotten convos
repetition
confusion in grasping new ideas
describe the middle stage of dementia?
more support needed in day to day life - reminders to eat, wash, dress, go toilet
increased forgetfulness
fail to recognise people
distress, anger, mood changes
may behave inappropriately
hallucinations, throw-back memories
how may the dental team notice middle stage dementia?
confusion and agitation
pt may not recognise dental team
repeatedly ask same qs
family notice changes
when should you give dementia pts dental appts?
morning
why may dementia pts be more prone to dry mouth/ candida?
polypharmacy
why may you not offer GA to a pt with dementia?
evidence suggests that dementia can worsen following GA
describe the late stage dementia?
increasingly dependent on others for care
inability to recognise familiar objects, surroundings or people
may be some flashes of recognition
increased physical frailty - eventually confined to wheelchair/ bed’
difficulty eating and swallowing, weight loss, incontinence and gradual loss of speech
what are the dental aspects of late dementia?
attendance
eating and swallowing difficulties
weight loss - difficult wearing dentures
loss of speech and communication
how could you tell someone has dental problems if they cant communicate with you7?
refusal to eat
frequently pulling at face or mouth
not wearing denture
increased restlessness, moaning or shouting
disturbed sleep
refusal to take part in daily activities
aggression
swelling
