SPECIAL CARE dementia

Question 1

what is dementia?

Answer 1

general term for loss of memory, language, problem-solving and other thinking abilities that are severe enough to interfere with daily life

Question 2

what are dementia risk factors?

Answer 2

age
female>male
ethnicity
down syndrome
medical factors
lifestyle factors
head injuries

Question 3

what are the medical risk factors for dementia?

Answer 3

type 2 diabetes
hypertension
high cholesterol
obesity
depression

Question 4

what are the lifestyle risk factors for dementia?

Answer 4

physical inactivity
smoking
unhealthy diet
excessive alcohol

Question 5

what type of dementia does head injuries from sports cause?

Answer 5

chronic traumatic encephalopathy

Question 6

what are the types of dementia?

Answer 6

alzheimer’s disease
vascular
mixed
lewy-body
fronto-temporal

Question 7

what does alzheimer’s disease present with?

Answer 7

short-term memory loss and word finding difficulties
with progression there is more confusion
may experience mood swings and frustration and become more withdrawn

Question 8

what is the biology behind alzheimers disease?

Answer 8

amyloid plaques
loss of connection between neurons
decrease in acetylcholine

Question 9

what infections are associated with alzheimers?

Answer 9

oral herpes
pneumonia
spirochete bacteria

Question 10

what is the association between perio disease and alzheimers?

Answer 10

gingivitis more common
proteins produced by p.gingivalis are present at higher conc in the brain

Question 11

what causes vascular dementia?

Answer 11

reduced blood flow to the brain
often due to a stroke, or a series of transient ischaemic attacks

Question 12

describe the deterioration of vascular dementia?

Answer 12

step-wise and linked to cerebrovascular changes in the brain

Question 13

what may vascular dementia look like on an MRI?

Answer 13

white areas where infarcts have been

Question 14

what is mixed dementia?

Answer 14

combination of alzheimers and vascular dementia

Question 15

what causes lewy-body dementia?

Answer 15

lewy bodies (protein deposits) in nerve cells

Question 16

what are symptoms of lewy-body dementia?

Answer 16

problems with thinking, movement, behaviour and mood
unpredictable changes in attention and alertness
visual hallucinations
disturbed sleep

Question 17

what disease is lewy-body dementia associated with?

Answer 17

parkinsons

Question 18

who does fronto-temporal dementia affect?

Answer 18

slightly younger

Question 19

what are symptoms of fronto-temporal dementia?

Answer 19

early features - personality change
can exhibit challenging behaviour as disinhibition
may have short temper, aggression, mood swings and sexually inappropriate behaviour

Question 20

how is dementia diagnosed?

Answer 20

personal and medical history
physical exam
bloods, urine, ECG
mental abilities checked

confirmed through CT/MRI, perfusion scan

Question 21

what are the questionnaires used for dementia pts?

Answer 21

MMSE - mini mental state exam

AMTS
6 - CIT
GPCOG
7 minute screen

Question 22

is there a cure for dementia?

Answer 22

no

Question 23

what is the general treatment for dementia?

Answer 23

talking therapies
reduce cardiac risk (halt deterioration of vascular types)
NSAIDs may slow progression
drug tx for alzheimers

Question 24

what are the 4 licensed drugs for alzheimers and parkinsons dementia?

Answer 24

donepezil
galantamine
rivastigmine
memantine

Question 25

how does memantine treat alzheimers?

Answer 25

it treats memory loss in alzheimers and lewy body dementia

Question 26

what is the new drugs approved in the UK to slow progression of alzheimers?

Answer 26

lecanemab

Question 27

describe the early stage of dementia?

Answer 27

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

Question 28

how may early stages of dementia be noticed by the dental team?

Answer 28

forgotten appts difficulty making decisions deterioration in OH forgotten convos repetition confusion in grasping new ideas

Question 29

describe the middle stage of dementia?

Answer 29

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

Question 30

how may the dental team notice middle stage dementia?

Answer 30

confusion and agitation pt may not recognise dental team repeatedly ask same qs family notice changes

Question 31

when should you give dementia pts dental appts?

Answer 31

morning

Question 32

why may dementia pts be more prone to dry mouth/ candida?

Answer 32

polypharmacy

Question 33

why may you not offer GA to a pt with dementia?

Answer 33

evidence suggests that dementia can worsen following GA

Question 34

describe the late stage dementia?

Answer 34

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

Question 35

what are the dental aspects of late dementia?

Answer 35

attendance eating and swallowing difficulties weight loss - difficult wearing dentures loss of speech and communication

Question 36

how could you tell someone has dental problems if they cant communicate with you7?

Answer 36

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