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

2. 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

3. 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

4. Healthy Brain vs. Advanced Alzheimer’s

5. 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

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

7. 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

8. 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

9. 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

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

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

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

13. 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.

14. 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

15. 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

16. 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.

17. 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

18. 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

19. Questions?

20. References
Wilkins, E. (2013). Clinical practice of the dental hygienist. (11th ed., pp. 798, ). Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer Business.
Rogers, J., (2009). The inflammatory response in alzheimer's disease. J Periodontal , 79,
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.
Porth, C.M., (2007). Essentials of pathophysiology concepts of altered health states. (2nd ed., pp ). Philadelphia: Lippincott Williams & Wilkins.
Healthy Brain Vs. Alzheimer’s Brain. Retrieved December 2, 2013, from
Home Remedies Alzheimers Disease. Retrieved December 2, 2013, from