Journal Summary:
The patient with Alzheimer's disease
Alzheimer's disease is the most common form of dementia. It is characterized by a gradual decline in cognitive processes, and utimately leads to total mental and physical disability. Victims of Alzheimer's disease usually show a gradual and steady deterioration in memory, orientation, emotional stability, language capacity, abstract thinking, motor skills and ultimately self care. The course of the disease varies between patients. It generally progresses through 3 stages over a period of 15 or more years. In the first stage, the first and most prominent sign is memory loss. The patient may also have time disorientation, lack of spontaneity, errors in judgment, and a notable decline in personal appearance and hygiene. During the second stage, patients suffer a more rapid and focal decline in intellectual capacity. The patient may show an inability to recognize self in a mirror. and they may find it difficult to carry out purposeful movements such as eating or walking. They may lose the ability to care for themselves. Other symptoms may include, the loss of the ability to understand, speech, to perform calculations, to recognize familiar objects, and they can experience partial or total loss of speech. In the third (terminal) stage, the patient is apathetic, disoriented, and unable to walk. It is common for them to experience body wasting and seizures. Other symptoms of the third stage are hyperorality, hypermetamorphosis, anxiety, aggressive behavior, hallucinations, delusional episodes, malnutrition, aspiration pneumonia, necorosis of the skin, and oral/ odontogenic problems. Patients usually die from a secondary infection due to a weakened immune system.
There are no reliable clinical tests to determine if a person has Alzheimer's disease. An MRI (magnetic resonance imaging), SPECT (single photo emission computed tomography), or a PET (position emission tomography) may provide some insight. There are also multiple questionnaires that are useful to assess cognitive impairment. There is also not a definitive cure. Several prescriptions are available to treat the cognitive symptoms of Alzheimer's disease (Tacrine, donepezil, and rivastigmine). Other therapeutic strategies that may improve cognition include, estrogen therapy, nosteroidal antinflammatory drugs, and the use of antioxidants.
Cognitve deficits cause significant decline from previous levels of functioning. They are accompained by gradual inability to perform adequate oral hygiene. Patients with a cognitive impairment also tend to have older and less clean prostheses. The submandibular salivary flow rate decreases with Alzheimer's patients. This increases the risk for caries, peridontal disease, dysfunctional speech,chewing, and swallowing; and dysgeusia or ageusia. Patient's with Alzheimer's disease also experience a higher incidence of maxillofacial injuries, and traumatic oral ulcerations. Often present is attrition, abrasion, and/or migration of the residual dentition. Cognitive function significantly diminishes during the second stage of Alzheimer's disease.
As soon as possible after the diagnosis of Alzheimer's disease, the patient should have a comprehensive physical evaluation by the oral health care provider. The evaluation should include documentation of medical history, followed by a clincial and radiographic examination. "When treating patients with Alzheimer's disease, the goals are to develop timely, preventive, and therapeutic strategies compatible with the patient's physical and emotional ability to undergo and respond to dental care and the patient's social and psychological, and emotional needs and desires. Clinicians must exercise empathy, congruance, and positive regard and strive to reach these goals with the same ethical, moral ,and professional standards of care as may be appropriate in the management of any other patient." In the early stages of the disease, patients are able to comprehend oral health care instructions, participate in oral health care-related decision making, and are able to cooperate in their treatment. Regardless of the state of the patient's cognitive deficiency, the patient should always be part of , rather than the object of, any discussion. As a patient's disease progresses, the oral health care provider should also provide the patient's family and/or caregivers with appropriate training to facilitate the implementation of tasks required to maximize the patient's oral health, comfort, independence, and quality of life.
Alzheimer's disease interferes with a person's ability to communicate dental symptoms of pain or dysfunction. The progressive deterioration of cogniton can cause agitation, disorientation, and inappropriate behavior in unfamiliar surroundings. These may interfere with a patient's ability to tolerate treatment in a dental office. So your dental management plan should include appropriate preventive strategies. Some preventive strategies include, using a power toothbrush to help remove plaque in a patient with diminished manuel dexterity, use of topical agents such as chlorhexidine to combat gingivitis, and flouride for high incidence of dental caries. As the mental condition of the patient deteriorates, they may become incapable of carrying out some or the entire dental hygiene regimen. It is important for the caregivers to understand and to be able to implement the preventive plan. If a problem does arise, the patient's physical and emotional state will determine whether the patient can arrive at and recieve treatment in a dental office. When it is not possible to treat in a dental office, a hospital operating room or outpatient surgical suite should be chosen. This will provide for the patient's comfort and safety while allowing for the delivery of the highest quality of dental care.
Personal Reflection: My grandfather had Alzheimer's disease. When I was twenty I quit my job as a medical assistant to move in with him. I became his full time caregiver. I can relate to many of the topics covered in this journal article. It reminds me a lot of the time I spent caring for him.
How will this journal article help with dental hygiene care: Although I have had experience dealing with someone who has Alzheimer's disease, I have never had one as a patient. This article gave me new ideas on how to handle a patient with Alzheimer's disease. I will now know what I can expect from this type of patient and how to communicate with his or her caregiver.
Additional information: According to the Alzheimer's Foundation of America the origin of the term Alzheimer's disease dates back to 1906 when Dr. Alois Alzheimer, a German physician, presented a case history before a medical meeting of a 51-year-old woman who suffered from a rare brain disorder. A brain autopsy identified the plaques and tangles that today characterize Alzheimer's disease.
APA citation: Gitto, C., Moroni, M., Terezhalmy, G., & Sandu, S. (2001). The patient with Alzheimer's disease. Quintessence International (Berlin, Germany: 1985), 32(3), 221-231.
There are no reliable clinical tests to determine if a person has Alzheimer's disease. An MRI (magnetic resonance imaging), SPECT (single photo emission computed tomography), or a PET (position emission tomography) may provide some insight. There are also multiple questionnaires that are useful to assess cognitive impairment. There is also not a definitive cure. Several prescriptions are available to treat the cognitive symptoms of Alzheimer's disease (Tacrine, donepezil, and rivastigmine). Other therapeutic strategies that may improve cognition include, estrogen therapy, nosteroidal antinflammatory drugs, and the use of antioxidants.
Cognitve deficits cause significant decline from previous levels of functioning. They are accompained by gradual inability to perform adequate oral hygiene. Patients with a cognitive impairment also tend to have older and less clean prostheses. The submandibular salivary flow rate decreases with Alzheimer's patients. This increases the risk for caries, peridontal disease, dysfunctional speech,chewing, and swallowing; and dysgeusia or ageusia. Patient's with Alzheimer's disease also experience a higher incidence of maxillofacial injuries, and traumatic oral ulcerations. Often present is attrition, abrasion, and/or migration of the residual dentition. Cognitive function significantly diminishes during the second stage of Alzheimer's disease.
As soon as possible after the diagnosis of Alzheimer's disease, the patient should have a comprehensive physical evaluation by the oral health care provider. The evaluation should include documentation of medical history, followed by a clincial and radiographic examination. "When treating patients with Alzheimer's disease, the goals are to develop timely, preventive, and therapeutic strategies compatible with the patient's physical and emotional ability to undergo and respond to dental care and the patient's social and psychological, and emotional needs and desires. Clinicians must exercise empathy, congruance, and positive regard and strive to reach these goals with the same ethical, moral ,and professional standards of care as may be appropriate in the management of any other patient." In the early stages of the disease, patients are able to comprehend oral health care instructions, participate in oral health care-related decision making, and are able to cooperate in their treatment. Regardless of the state of the patient's cognitive deficiency, the patient should always be part of , rather than the object of, any discussion. As a patient's disease progresses, the oral health care provider should also provide the patient's family and/or caregivers with appropriate training to facilitate the implementation of tasks required to maximize the patient's oral health, comfort, independence, and quality of life.
Alzheimer's disease interferes with a person's ability to communicate dental symptoms of pain or dysfunction. The progressive deterioration of cogniton can cause agitation, disorientation, and inappropriate behavior in unfamiliar surroundings. These may interfere with a patient's ability to tolerate treatment in a dental office. So your dental management plan should include appropriate preventive strategies. Some preventive strategies include, using a power toothbrush to help remove plaque in a patient with diminished manuel dexterity, use of topical agents such as chlorhexidine to combat gingivitis, and flouride for high incidence of dental caries. As the mental condition of the patient deteriorates, they may become incapable of carrying out some or the entire dental hygiene regimen. It is important for the caregivers to understand and to be able to implement the preventive plan. If a problem does arise, the patient's physical and emotional state will determine whether the patient can arrive at and recieve treatment in a dental office. When it is not possible to treat in a dental office, a hospital operating room or outpatient surgical suite should be chosen. This will provide for the patient's comfort and safety while allowing for the delivery of the highest quality of dental care.
Personal Reflection: My grandfather had Alzheimer's disease. When I was twenty I quit my job as a medical assistant to move in with him. I became his full time caregiver. I can relate to many of the topics covered in this journal article. It reminds me a lot of the time I spent caring for him.
How will this journal article help with dental hygiene care: Although I have had experience dealing with someone who has Alzheimer's disease, I have never had one as a patient. This article gave me new ideas on how to handle a patient with Alzheimer's disease. I will now know what I can expect from this type of patient and how to communicate with his or her caregiver.
Additional information: According to the Alzheimer's Foundation of America the origin of the term Alzheimer's disease dates back to 1906 when Dr. Alois Alzheimer, a German physician, presented a case history before a medical meeting of a 51-year-old woman who suffered from a rare brain disorder. A brain autopsy identified the plaques and tangles that today characterize Alzheimer's disease.
APA citation: Gitto, C., Moroni, M., Terezhalmy, G., & Sandu, S. (2001). The patient with Alzheimer's disease. Quintessence International (Berlin, Germany: 1985), 32(3), 221-231.