Dementia, Alzheimer's, and Seizures

dementia

general term for loss of memory, language, problem solving, and judgement that interferes with activities of everyday life; progressive and fatal brain disorder

most common type of dementia

alzheimer's

early onset

rare and reported in individuals in 30s and 40s

late onset

most common, reported in individuals older than 65

risk factors

age, genetics, HBP, diabetes, periodontal disease

early signs and symptoms

- memory loss that affects daily life

- challenges in planning and solving

- confusion with time

- not being able to find/form words

- withdrawal from work or social activities

- changes in mood personality

areas of the brain affected

cognitive, behavioral, functional

average duration of stages

8-10 years

early stage

2-4 years

middle stage

2-10 years

late stage

1-3 years

common early challenges

poor judgement, driving, wandering, repetition

common middle stage challenges

poor hygiene, delusions and hallucinations, challenges in communication

middle stage challenges for dental office

should not be driving, increased risk of infection, decreased ability to make decisions

common late stage challenges

does not recognize family, mute, no self care

bacteria found in pts with AD related to dentistry

P. gingivalis; systemic inflammation

perio and alzheimer's

chronic perio leads to 1.7 fold increase in risk of alzheimer's

techniques in office

reduce stimuli, be patient, maintain eye contact

tips for communication

avoid sudden movements, use gestures and words, don't take behaviors personally

treatment for AD

no cure- physical therapy and exercise, medication, adult daycare, pet therapy

greatest risk for end of life with alzheimer's

falling

seizure

paroxysmal event resulting from abnormal brain activity; may cause loss of consciousness, unprovoked and involuntary

causes of seizures

genetic, metabolic, immune, or unknown

most common seizure

epilepsy: recurrent seizures

epilepsy can be caused by

high fever, trauma, stroke, genetic

triggers

hormones, stress, sleep deprivation, drug use

prodromal/preictal

may get a sign seizure is coming

aural phase

sense of deja vu, abnormal taste or smell

ictal phase

active seizure phase, lasts seconds to minutes

postictal phase

sleepiness, confusion, headache

grand mal seizure

- 1-3 mins

- loss of consciousness/stiffness

- pale, confused, and tired

- bite tongue

absence seizure (petit mal)

- blank stare

- common in children

- quickly returns to full awareness

treatment for seizure

antiepileptic drugs

side effects of medications

rash, gingival hyperplasia, fatigue, memory loss, hair loss

common meds

lamotrigine, topiramate, gabapentin, phenobarbital, phenytoin

oral findings

tongue bruising, tongue scarring, fractured teeth, gingival hyperplasia

emergency protocol

terminate tx, after 5 mins call 911, check oral for trauma, call for transportation

documentation

type, length, recovery, procedure phase, oral injuries, who is transporting them