Alzheimer’s and Parkinson’s Disease

1. Alzheimer’sandParkinson’s Disease Chan, Joanna & Dorisca, Lamar

2. 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.

3. Stages of Alzheimer’s (Symptoms) • 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. • 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. • In this stage the person will be bedridden, mute and experience encopresis.

4. 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-aspartateantagonist are used for moderate to severe cases.

5. 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.

6. 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.

7. N-methyl D-aspartate antagonist Mechanism Of Action Drug Used Namenda (memantine) – Common side effects include:Dizziness, headache, constipation, confusion. • To control glutamate, which is an important brain chemical, and its activation. Excess glutamate can have toxic effects.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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

13. Alzheimer's & Parkinson’s