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Alzheimer's Disease

By: Kim Le, Courtney Campbell, Ashlyn Bruno

What is
Alzheimers?
Alzheimers disease is a progressive irreversible
brain disorder characterized by intellectual and
cognitive disturbance, behavioral changes, and
eventually a state of complete dependence
Alzheimers is 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
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

Alzheimers is not a normal part of aging


however greatest risk factor is increasing age

Occurrence
Alzhemiers 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

Symptoms (7 stages)
3. MILD COGNITIVE DECLINE (EARLY
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

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Becoming moody or withdrawn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

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

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

Treatment
No proven treatment to preventor 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 antipsychotics

Goals of dental hygiene care


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

DH
Early
Stages
CONSIDERATIONS
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

DH 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

Caregiver Instructions
Brush teeth twice a day
Floss teeth once a day
Clean mouth and dentures after every meal
Visually inspect the patients teeth and
gums once a month
Schedule regular dentist visits

When treating a patient with


Alzheimers 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. All the above

When symptoms of Alzheimers are


suspected, the dh should?
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

Indication & contraindications for dental treatment


Health be impacted
will medical treatment or medication impact oral
health how?
Periodontal management

Pre med
Patient postioning
Ultrasonic use
recall intervals
appointment lenght

What is Alzheimers disease?


A. Sexually transmitted disease
B. Heart disease
C. Progressive, irreversible brain disorder
D. Parkinsons disease

References
Friedlander, A. H., Norman, D. C., Mahler, M. E., Norman, K. M., & Yagiela, J. A. (2006).
Alzheimer's disease. Psychopathology, medical management and dental implications. The
Journal Of The American Dental Association, 1371240-1251.
doi:10.14219/jada.archive.2006.0381
Moore, K. D. (2000). Book Review: There's Still a Person in There: The Complete Guide to
Treating and Coping with Alzheimer's. American Journal Of Alzheimer's Disease & Other
Dementias, 15(2), 72. doi:10.1177/153331750001500202
Gruetzner, H. (2001). Alzheimer's : A Caregiver's Guide and Sourcebook. New York: John Wiley
& Sons, Inc. [US].
Martande, S. S., Pradeep, A. R., Singh, S. P., Kumari, M., Suke, D. K., Raju, A. P., & ... Chatterji, A.
(2014). Periodontal health condition in patients with Alzheimers disease. American Journal Of
Alzheimer's Disease And Other Dementias, 29(6), 498-502. doi:10.1177/1533317514549650
Votruba, K. L., Persad, C., & Giordani, B. (2015). Patient mood and instrumental activities of
daily living in Alzheimer disease: Relationship between patient and caregiver reports. Journal Of
Geriatric Psychiatry And Neurology, 28(3), 203-209. doi:10.1177/0891988715588829
Abbayya, K., Puthanakar, N. Y., Naduwinmani, S., & Chidambar, Y. S. (2015). Association
between Periodontitis and Alzheimer's Disease. North American Journal Of Medical Sciences,
7(6), 241-246. doi:10.4103/1947-2714.159325
Monastero, R., Caruso, C., & Vasto, S. (2014). Alzheimer's disease and infections, where we
stand and where we go. Immunity & Ageing, 11107-114. doi:10.1186/s12979-014-0026-4
Wilkins, E., (2013). Clinical Practice of the Dental Hygienist. 802-803

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