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Geriatrics > 5. Alzheimer's and Parkinson's Disease > Flashcards

5. Alzheimer's and Parkinson's Disease Flashcards

1
Q

Aging increases the risk of what other changes

A
  • 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
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2
Q

Define delirium

A

impairment of attention and conciousness

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3
Q

Delirium is (temporary/permenant)

A

temporary (or transient)

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4
Q

Delirium is ususally assoc. with underlying medical disorder such as

A

Electrolyte imbalance

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5
Q

T/F Dementia is a disease

A

f it is a syndrom or a constellation of syndroms

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6
Q

Characteristics of dementia are

A
  • Decline in memory
  • Intellect
  • Personality
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7
Q

What is the most common cause of dementia

A

Alzheimer’s

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8
Q

List some of the different types of dementia

A

-Alzheimer’s
-Mixed dementia
-Lewy Body dementia
-Parkinson’s dementia
-

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9
Q

Describe lewy body denentia

A
  • Neurodegenerative disorder associated with abnormal structures found in the brain (Lewy bodied)
  • Clumps of cells with cellular inclusions containing alpha- synuclein
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10
Q

Symptoms of Lewy Body dementia

A
  • Fluctuating altertness and or cognition
  • Recurrent visual hallucinations
  • Parkinson’s symtoms
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11
Q

What is the most common form of dementia

A

Alzheimer’s

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12
Q

Alzheimers involves parts of the brain that control

A
  • though
  • memory
  • language
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13
Q

Brain changes that occur in Alzheimer’s

A
  • Amyloid plaques
  • Tangled bundles of fibers (neurofibrillary tangles)
  • Dead brain cells
  • Disrupted connections between brain cells
  • Lower levels of neurotransmitter
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14
Q

What are the theories of causation for alzhiemers

A
  • Amyloid hypothesis
  • Tau hypothesis
  • Inflammation
  • Free radicals
  • Cholinergic hypothesis
  • Type III diabetes
  • Infection
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15
Q

Describe the infection hypothesis

A

Miklossy- Studied determined people with Alzhiemer’s had larger conc. of oral spirochetes in their brains

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16
Q

Describe the inflammation hypothesis

A
  • IL-1 is critical to processing APP

- IL-6 and TNF-alpha trigger amyloid deposition

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17
Q

Why has the death toll for alzheimers increased throughout the years while all other diseases have declined

A

there are more old people and because we don’t know much about how to cure it

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18
Q

Alzhiemer’s disease is characterized by

A

brain cortex atrophy

-Deficiency of acetylcholine and associated enzymes

19
Q

What are the three stages of Alzheimer’s

A
  • Early
  • Moderate
  • Advanced
20
Q

Describe Early Alzheimer’s

A
  • 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
21
Q

Describe moderate Alzheimers

A
  • 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)
22
Q

Describe advanced Alzheimer’s

A
  • Weight loss
  • Seizures, skin infections, difficulty swallowing
  • Groaning, moaning or grunting
  • Increased sleeping
  • Lack of bladder and bowel control
23
Q

What pharmacologic class of drug is commonly used to treat alzheimer’s

A

acetylcholinesterase inhibitors

24
Q

What is one of the most common drugs used to treat alzheimer[s

A

denepezil

25
Q

What is one drug commonly used to treat alzheimers (out of the 5 approved) that is not an acetylcholinesterase inhibitor

A

memantine

26
Q

What is the pharmacologic class of memantine

A

glutamate receptor antagonist

27
Q

Describe the Mini Mental State Exam (MMSE)

A

11-question measure that tests 5 areas of cognitive function

  • Orientation
  • Registration
  • Attention
  • Calculation
  • Recall
  • Language
28
Q

Max score on the MMSE

A

30

29
Q

A score lower than _ on the MMSE indicates cognitive impairment

A

23

30
Q

Describe the mini cog test

A
  • Tell the patient 3 words
  • Ask them to repeat the words
  • Write a clock
  • Repeat the words
31
Q

People that take meds for dementia should use what preventative measures to protect against caries

A
  • Fluoride varnish and chlorhexidine

- Frequent recalls

32
Q

Tx planning someone with early dementia

A
  • Anticipate oral decline
  • Eliminate potential sources of pain and pathology and infection asap
  • Aggressive elimination of potential problems
33
Q

Tx plan for moderate dementia

A

-Expect uncooperative behavior
-Short appointments
-Silver Diamine fluoride
0OH is totally the caregiver’s responsibility
-Minimal changes due to inability of patient to adapt

34
Q

Tx plan with late demential

A
  • Avoid complex treatment
  • Consider IV sedation or general
  • Focus on removing unrestorable teeth and oral hygiene
35
Q

Parkinson’s diseases is characterized by

A

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
36
Q

Most likely etiology of parkinson’s diseases

A
  • 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
37
Q

Oral symptoms of Parkinson’s

A
  • 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)
38
Q

What is tardive dyskinesia

A

involuntary orofacial movements from long term levodopa use

39
Q

What are the contraindications to routine dentistry for parkinson’s patients

A

none

40
Q

is premed required for parkinson’s patients

A

no

41
Q

Parkinson’s dental issues

A
  • 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
42
Q

Challenges to dentist with parkinson’s patient

A
  • 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
43
Q

Unreported oral discomfort may manifest as

A
  • Increased restlessness
  • Impaired sleep
  • Moaning or shouting
  • Refusal to eat favorite foods
  • Refusal to cooperate
  • Aggressive behavior

Geriatrics (11 decks)

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