Neurological Diseases: MS and Alzheimer's

Neurological Diseases

• Neurological diseases are a broad category, including conditions like Multiple Sclerosis and Alzheimer's Disease.
• This presentation focuses on the epidemiology, clinical manifestations, diagnosis, treatment, and oral health considerations for these conditions.

Multiple Sclerosis

• Epidemiology & Etiology:
  • MS is characterized by inflammation, demyelination, and scarring (gliosis) in the central nervous system (CNS).
  • Myelin is crucial for nerve impulse transmission; its destruction slows or blocks these impulses.
  • The onset typically occurs between 20 and 45 years of age.
  • MS is more common in women than men (2:1 ratio).
  • The cause remains unknown but is associated with genetic susceptibility.
  • Autoimmune mechanisms are likely involved in its pathogenesis.
• Clinical Features:
  • Symptoms vary depending on the affected areas of the CNS.
  • Common manifestations include visual changes, limb weakness, spasticity, ataxia, bladder and bowel dysfunction, and sensory impairment.
• Diagnosis:
  • There's no single definitive test for MS.
  • Diagnosis relies on evaluating evidence of dissemination in space.
  • Common diagnostic tools include MRI, cerebrospinal fluid (CSF) analysis, and evoked potentials.
• Management:
  • Therapy for MS is categorized into three types: acute attack treatment, disease-modifying therapies, and symptomatic therapy.
  • Treatment strategies include steroids, interferons, monoclonal antibodies, and symptomatic medication like anticonvulsants, benzodiazepines, and pain medications.
• Oral Health Considerations:
  • Individuals with MS might experience trigeminal neuralgia (electric shock-like pain) as a presenting symptom.
  • Facial weakness and paralysis are also possible.
  • Elective dental treatment should be avoided during acute exacerbations due to potential mobility and airway compromise.

Alzheimer's Disease

• Epidemiology & Etiology :
  • Alzheimer's Disease (AD) is the prevalent form of dementia.
  • It's a progressive disease that leads to memory loss and other cognitive impairments.
  • It begins with mild memory problems and progresses to difficulty with daily tasks and communication impairments.
  • AD involves parts of the brain controlling thought, memory, and language.
  • Globally, dementia prevalence is estimated at 24 million and projected to rapidly increase by 2050.
  • AD constitutes up to 65% of new dementia cases in Western countries.
  • In Saudi Arabia, AD affects approximately 130,000 individuals.
  • AD is characterized by amyloid plaques and neurofibrillary tangles in the brain which are absent in healthy individuals.
  • Massive apoptosis (programmed cell death) occurs in later stages in the brain tissue.
• Clinical Features:
  • The disease typically progresses through stages, beginning with mild memory loss and cognitive impairment.
  • Common symptoms include difficulty with familiar tasks, misplacing items, poor decision-making, and changes in mood or personality.
• Diagnosis:
  • Diagnosis often involves a Mini-Mental State Examination (MMSE) to assess cognitive abilities, along with neurological testing and potentially PET scans, MRI, and CSF analysis.
• Management:
  • Currently, no cure exists for AD.
  • Treatment focuses on slowing the disease progression, using strategies like cholinesterase inhibitors (approved by the FDA for mild to moderate cases) and newer monoclonal antibodies.
  • Side effects like nausea, vomiting, diarrhea, weight loss, bradycardia, and syncope are possible, when using medications approved by the US Food and Drug Administration to treat the condition
• Oral Health Considerations:
  • Patients with AD might be at higher risk for oral health problems like caries, periodontal disease, and temporomandibular joint issues.
  • Dental care during acute exacerbations should be limited and focus on preventative measures and patient safety.
  • Caregiver involvement can be beneficial, since they can verify information or assist in providing information that better aids the patient's understanding.

References & Further Reading

• Step-up to medicine 5th edition
• Harrison's Principles of Internal Medicine 20th edition
• NEJM
• Amboss