1. Dementia and Dentistry
An Overview, by Natalie Wilson

2. What is Dementia?
ICD-10: “as a disorder with deterioration in both memory and thinking which is sufficient to impair personal activities of daily living...patients have deficits in thinking and reasoning in addition to the memory disturbance.”
A syndrome - a range of clinical symptoms that combine to form an overall clinical picture
Can be over 100 causes

3. Prevalence Increasing - recognised global time bomb
Currently vastly underdiagnosed (up to 55% of those affected)
Estimated >1million diagnosed in UK by 2025
1 in 3 will have some form of dementia

4. Diagnosis
1. Patient exhibits changes in cognition, function and personality for at least a year.
2. Thorough history with family member/carer present
3. Several short cognitive exams carried out by GP
4. Blood testing
5. Specialist memory service referral
6. Further testing
National Dementia Commissioning for Quality and Innovation requires A&E admissions for >75y/o to screen for memory problems

5. Types of Dementia
Alzheimer’s
Vascular
Mixed
Lewy Body
Frontal Lobe

6. Alzheimer’s Most common (60%)
Chemical changes in nerve cells in the brain - plaques appear
Typically presents with short term memory loss and word difficulties
Forgetting names, places, events
Mood swings and frustration
Become withdrawn
NICE recommended drug of choice is Donepizil (Aricept) - anti cholinergic

7. Normal healthy brain vs Alzheimer’s affected brain

8. Vascular Dementia
Caused by congestion of small blood vessels in the brain - affecting supply of blood to the brain
Often diagnosed following a stroke or series of Transient Ischaemic Attacks
Linked to cerebrovascular changes in the brain
Stepwise deterioration, similar signs as AD
Managed with therapeutic interventions as for coronary artery disease
Possibly also anti coagulant therapy to prevent clots

9. MRI of normal brain vs Vascular Dementia

10. Mixed Dementia
Combination of Alzheimer’s disease and vascular dementia
Changes representing more than one type of dementia occur simultaneously in the brain.
In the most common form, the plaques and tangles associated with nerve cells in Alzheimer's disease are present along with blood vessel changes associated with vascular dementia.

11. Lewy Body Dementia Protein deposits on nerve cells
Named after physician who discovered these
Often present with sleep disturbance and halucinations
Can cause Parkinson’s Disease
Symptoms depend on area of brain affected - motor/cognitive
Management of symptoms and support of patients

12. Histology of normal brain
tissue
vs Lewy body

13. Frontal Lobe Dementia
Generally affects younger people (60s) than other dementias
Frontal and temporal lobes damaged
Early features include personality change and problems with executive function
Can be aggressive/short tempered
Mood swings and sexually inappropriate behaviour
Linked to MND
MDT support

14. Dementia and Oral Disease
Research suggests less frequent toothbrushing and accumulation of plaque may be early indications of cognitive decline
GDP may spot this before family member notices memory loss
Systemic inflammation from periodontal disease can affect the brain, disrupt neurons and cause poor memory
Carers may ask YOU for advice

15. Signs for the Dental Team
Early Stages:
Missing/incorrect appointments
Difficulty in decision making
Deterioration in OH
Repetition of questions
Confusion/difficulty grasping new ideas

16. Middle Stages:
Need reminding and help to carry out daily personal care
Failure to recognise dental team
Failure to remember answers to questions, despite repeatedly asking

17. Later Stages:
Increasing difficulty to attend surgery due to mobility issues
May be confined to bed
Difficulty in eating/swallowing
Weight loss
Increasing difficulty in communicating

18. Dementia and the Dental Team
Need to be aware of early signs and how to manage middle and late stages
Many potential issues to manage:
Communication: language, time, prompts, explanation
Consent: Mental Capacity Act 2005 (Eng), PoA/ IMCA
Access: mobility/carers, time of day, doms visits
Tx planning: simple, maintenance + prevention, dents
Cooperation: capacity, anxiety/depression, sedation
Drug therapy: oral effects, interactions, metabolism

19. What can we do?
Ensure staff are properly trained in recognising/managing patients with dementia
Sensitive conversation with patient and family
Can speak to GP
Encourage patients to seek diagnosis - early Tx slows progression
Be patient and supportive of patient needs
Ensure focus is on patient comfort in later stages
Ensure caregivers carry out regular oral care
Help patients access care services

20. References
dementia
tID=161
Boyle, C; Edwards, J A; Ford L: Dementia and Dentistry. Dental Update, p464, June 2015

21. Thanks for Listening