Download Alzheimer*s and Parkinson*s Disease

Alzheimer’s
and
Parkinson’s
Disease
Chan, Joanna
&
Dorisca, Lamar
What is Alzheimer’s Disease
 Alzheimer’s disease is a form of dementia.
 It is a progressive neurological disease that affects the
memory, thinking, and language areas of the brain.
 Alzheimer’s causes changes in the brain nerve cells and
these changes cannot be reversed.
 Alzheimer’s disease generally occurs in the elderly
population.
 After the age of 65 the incidence of this disease doubles
every five years.
Stages of Alzheimer’s
(Symptoms)
① During the first stage a person with Alzheimer’s will
start to be forgetful. They will start to have trouble
with finding what words the want to say.
② At this stage the person’s memory will worsen. Along
with becoming more forgetful, their speech also
becomes worse. They have problems with self care
and may even start to have hallucinations.
③ In this stage the person will be bedridden, mute and
experience encopresis.
Treatment
 Despite the extensive research done on this disease there is
no cure for it.
 Certain medications are used to help with the management
of this disease.
 There two types of drugs used for the management of mild
to moderate cases and moderate to severe cases.
 Cholinesterase inhibitors are used for mild to moderate
cases.
 N-methyl D-aspartate antagonist are used for moderate to
severe cases.
Cholinesterase Inhibitors
 MOA: Inhibit the breakdown of cholinesterase, which is
an essential chemical in the brain for memory and
thinking. It cannot be used for severe Alzheimer’s
because as the disease progresses the brain produces
less cholinesterase. There are three types of drugs in
this category that is used for Alzheimer’s.
Cholinesterase Inhibitors (cont.’d)
 Razadyne (galantamine) - Common side effects include:
Nausea, vomiting, diarrhea, weight loss, loss of appetite.
 Exelon (rivastigmine) - Common side effects include:
Nausea, vomiting, diarrhea, weight loss, loss of apvpetite,
muscle weakness.
 Aricept (donepezil) – Common side effects include:
Nausea, vomiting, diarrhea. Drug Interactions: May increase
effects of antipsychotics; beta-blockes; cholinergic agonist.
Anticholinergics; neuromuscular-blocking agents & St.
John’s Wort may decrease the effect of donepezil.
N-methyl D-aspartate antagonist
Mechanism Of Action
 To control glutamate, which
is an important brain
chemical, and its activation.
Excess glutamate can have
toxic effects.
Drug Used
 Namenda (memantine) –
Common side effects
include: Dizziness,
headache, constipation,
confusion.
Dental Team
 Patients with Alzheimer’s may be neglectful of their dental health and
oral hygiene, because of their forgetfulness. Medications they are
taking can cause Xerostomia, which can lead to an increase in caries.
 The patient should brush twice a day with a powered toothbrush to
make it easier on the patient and/or caregiver. If toothpaste poses a
problem than it should not be used.
 Floss teeth once a day.
 Since patients with Alzheimer’s do not swallow well, their denture (if
one is worn) should be removed and cleaned after every meal and
the gingival and palate should be brushed with a soft toothbrush.
 The patient should have a monthly check-up dental appointment.
Parkinson’s
 Parkinson’s disease is a disabling condition of the brain
characterized by slowness of movement, shaking, stiffness, and in
later stages, loss of balance. This is due to the lack of dopamine
being produced in the brain.
 Dopamine is a neurotransmitter; it is a chemical messenger that
helps in transmission of signals in the brain and other vital areas.
Dopamine regulates emotional responses, our “fight or flight”
response, cognitive functions (concentration, memory and problem
solving), and more importantly movement.
 Nerve cells that are responsible for making dopamine are slowly
deteriorating. Without dopamine, the brain cannot properly send
messages, resulting in loss of muscle function.
Symptoms
 Tremors
 Difficulties in walking, eating,
swallowing and balancing
 Memory loss
 Dry mouth
 Depression and more
 There is no cure for PD, but
we do have medications that
can control these symptoms.
Dopamine Precursor
 Levodopa & Carbidopa are used together.
 MOA: Levodopa converts into dopamine, Carbidopa
prevents the breakdown of Levodopa in the bloodstream,
therefore increasing Levodopa in the brain and reducing
side effects. It also enhances Levodopa.
 Adverse Effects: Dizziness, nausea/vomiting, anxiety,
confusion, clumsiness, and ETC.
 Drug Interactions: Vitamin B6, Clorgyline, Iproniazid,
Pargyline, Phenelzine, Isocarboxazid, and ETC.
 Contradictions: Diabetes mellitus, heart or blood vessel
disease, kidney illness, seizure disorders, and ETC.
Dental Team
 Patients with PD will most likely present calculus and/or
caries due to poor oral hygiene care.
 We would recommend a PD patient to use a power brush
and an automatic flosser to help cope with the difficulties.
 Since there is a risk of choking in PD patients, 5% Na
fluoride varnish or Stannous fluoride gel can be used.
 If the patient wears dentures, he/she should remove it once
a day and clean it with a denture brush and/or Polident.
 Make the appointment shorter/more visits, rather than
longer/less visit
Alzheimer's & Parkinson’s