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- 1. Definition Brain degenerative disorderthat gradually destroys the ability to remember, reason, learn, and imagine. Stages/ Symptoms • Stage 1: Early/Mild Stage • Noticed in conversation • Increased forgetfulness • Losing everyday objects • Stage 2: Middle/Moderate stage • Longest stage • Difficult to communicate • Losing direction easily • Mood/behavior changes • Disorientation/confusion • Stage 3: Severe/ Late Stage • Difficulty swallowing, walking, speaking Prevention • Regular exercise • Mind-stimulating activities • Diet modifications Prevalence • Affects approximately 5 million Americans • Sixth leading cause of death in the United States Definition Disorder which is characterized by abnormally high blood sugar due to defective insulin secretion, action, or both. General Symptoms • Polyuria Symptoms associated with Type II • Weight gain • Darkened skin • Fatigue • Slow healing • Blurry vision Prevention • Type I: non-preventable • Type II: weight management, healthy diet, and exercise Etiology • Type I: autoimmune; pancreatic insulin producing cells are destroyed • Type II: inability to produce enough insulin Type II • Increase glucose • Glucose in gingiva causes periodontium to heal slowly • Created an ongoing inflammation in the mouth • Inflammatory cells travel throughout the body Prevalence • Affects 25.8 million people in the United States Bridging the Gap History • Type III Diabetes hypothesis was developed in 2005 with research at Brown University • Research is relatively new and does not give a conclusive link Pathogenesis • Developing Type II Diabetes puts individuals at an increased risk of developing Alzheimer’s disease later in life • Patients with Type II Diabetes are at an increased risk of Alzheimer’s Disease • Type I Diabetics exhibit more control of their blood glucose because of insulin use and therefore are less likely to develop Alzheimer’s disease • Hyperglycemic diabetic patients have increased oxidative stress • Neurotoxins are released which decreases acetylcholine production • Compromises endothelial lining of cerebral blood vessels • Decreased acetylcholine production and compromised endothelium encourages the formation of deadly beta-amyloid plaques • Beta-amyloid plaque accumulates in the brain causing neurofibrillary tangles • Leads to deterioration of white matter • Exacerbates Diabetes by killing beta islet cells Dental Considerations • The comorbidity of Alzheimer’s and Diabetes puts patients at a greater risk for tooth loss • Dental hygiene appointments are more frequent than doctor visits • Disease can be detected earlier • Hygienists can detect mental and physical changes with their patients • Referrals may be necessary TYPE III DIABETES: ALZHEIMER’S TIFFANYKONG,LEANNAMYERS,JACOBREXING UNIVERSITYOFSOUTHERNINDIANA COLLEGEOFNURSINGANDHEALTHPROFESSIONS Alzheimer’sDiabetes Diabetic patient (on the left) shows less brain activity compared to a healthy patient (on the right). The Alzheimer’s brain (on the right) is significantly smaller than its healthy counterpart (on the left). Dental Hygiene Intervention Dental teams have an opportunity to be proactive towards each patient’s overall health and well-being. Glucose testing is important for offices to include as a part of each patient’s clinical assessment. Testing will allow the dental hygienist to make the connection between a patient’s physical assessment and the state of their oral cavity, including inflammation and periodontal status. If a patient is currently diagnosed with Type II Diabetes Mellitus, it is our responsibility to be aware of possible cognitive decline issues. Dental Hygienist must pay attention to the signs of this condition and how it can lead to dementia, and eventually Alzheimer’s. While these subjects can be difficult to address, it is our duty to help our patients understand the signs and symptoms for these conditions, as well as interventions they can use to cope with their diagnosis. Dental Hygienist can recommend a physician consult and further cognitive testing with a specialist if necessary. Dental Implications • Xerostomia • Enlarged salivary glands • Fungal infections • Increased glucose in saliva • Increased caries risk • Periodontal disease • Increase healing time Dental Considerations • Morning appointments allow for better glucose control • Educate patients about importance of oral care • Add Doxycycline for periodontitis control Dental Considerations • Morning appointments • Recommend powered toothbrushes • Communicate with caregivers if needed • Focus on oral health education Dental Implications • Lack of oral care at home • Sporadic dental appointments • Forget dental routine • Xerostomia • Gingival diseases • Increased caries risk • Polydipsia • Polyphagia https://classconnection.s3.amazonaws.com/403/flashcards/36 29403/png/atrophy-14249AC1AD912A56462.png https://fellowshipofminds.files.wordpress.com/2015/05/alzhei mers-brain-cells.jpg http://www.joslin.org/bin_from_cms/brain_IJ.jpg