Neurological & Alzheimer's Diseases PDF

Neurological Diseases Internal Medicine Department  Epidemiology & Etiology Multiple Clinical Manifestations Sclerosis Diagnosis & Treatment Oral Health Considerations  Multiple Sclerosis – Epidemiology & Etiology Multuple sclerosis (MS) is charact...

Neurological Diseases Internal Medicine Department  Epidemiology & Etiology Multiple Clinical Manifestations Sclerosis Diagnosis & Treatment Oral Health Considerations  Multiple Sclerosis – Epidemiology & Etiology Multuple sclerosis (MS) is characterized by multiple areas of central nervous system (CNS) white matter inflammation, demyelination, and gliosis (scarring) Myelin is critical for propagation of nerve impulses When myelin is destroyed in MS, slowing and/or complete block of impulse propagation is manifested by abnormal muscular and neurologic signs and symptoms  Multiple Sclerosis – Epidemiology & Etiology The age at onset is typically between 20 and 45 years More common in women than men (2:1) The cause of MS is unknown, genetic susceptibility to MS clearly exists Substantial evidence suggests that autoimmune mechanisms are involved in the pathogenesis of MS  Multiple Sclerosis – Clinical Features The clinical manifestations of MS depend on the areas of the CNS involved, and frequently affected areas include the optic chiasm, brainstem, cerebellum, and spinal cord Visual Changes Limb weakness Spasticity Ataxia Bladder and bowel dysfunction sensory impairment  Multiple Sclerosis – Diagnosis There is no definitive diagnostic test for detection of MS Once MS is suspected, the clinician must evaluate for evidence of dissemination in space MRI CSF analysis Evoked potentials  Multiple Sclerosis – Management Therapy for MS can be divided into three categories: (1) treatment of acute attacks, (2) disease- modifying therapies, and (3) symptomatic therapy. Steroids Interferon Monoclonal antibodies Symptomatic treatment (anticonvulsants, benzodiazepines, tricyclic antidepressants, smooth muscle relaxants, anticholinergic agents, and various pain medications)  Multiple Sclerosis – Oral Health Considerations Individuals may present to the oral health-care provider with signs and symptoms of MS Trigeminal neuralgia (TGN), which is characterized by electric shock–like pain, may be an initial manifestation of MS (Refer to a medical care provider) Facial weakness and paralysis may also be evident It is recommended to avoid elective dental treatment in MS patients during acute exacerbations of the disease due to limited mobility and possible airway compromise  Epidemiology & Etiology Alzheimer's Clinical Manifestations Disease Diagnosis & Treatment Oral Health Considerations  Alzheimer’s – Epidemiology & Etiology Alzheimer’s disease is the most common type of dementia It is a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment Alzheimer’s disease involves parts of the brain that control thought, memory, and language It can seriously affect a person’s ability to carry out daily activities  Alzheimer’s – Epidemiology & Etiology The global prevalence of dementia is estimated at 24 million and has been predicted to quadruple by the year 2050 Alzheimer’s disease (AD) is the most common form of dementia in Western countries, accounting for up to 65% of new cases In Saudi, Alzheimer’s disease is estimated to affect around 130,000 individuals https://www.moh.gov.sa/en/HealthAwareness/healthDay/2019/Pages/HealthDay-2019-09-21.aspx  Alzheimer’s – Epidemiology & Etiology Major pathological hallmarks of AD are amyloid plaques and neurofibrillary tangles that are absent in healthy brain tissue Massive apoptosis occurs in later stages of the development of AD in the human brain (brain slices)  Alzheimer’s – Clinical Features Memory loss that disrupts daily life, such as getting lost in a familiar place or repeating questions Trouble handling money and paying bills Difficulty completing familiar tasks at home, at work or at leisure Decreased or poor judgment Misplacing things and being unable to retrace steps to find them Changes in mood, personality, or behavior  Alzheimer’s – Diagnosis Mini-Mental State Examination may be used to assess global cognitive abilities PET scan MRI CSF analysis  Alzheimer’s – Management There is no cure for AD, and therapy is aimed at slowing the progression of the disease Cholinesterase inhibitors approved by the US Food and Drug Administration to treat mild to moderate cases of AD Common side effects of these medications include nausea, vomiting, diarrhea, weight loss, bradycardia, and syncope New monoclonal antibody drug recently approved the USFDA  Alzheimer’s – Oral Health Considerations Patients with AD appear to be at higher risk for developing coronal and root caries, periodontal infections, temporomandibular joint abnormalities, and orofacial pain compared to healthy subjects. Patients with AD can become frustrated, irritable, and possibly combative when confronted with unfamiliar circumstances or with questions, instructions, or information that they do not understand The presence of a caregiver may be beneficial as they can verify patient information, interpret patient behavior, and alleviate anxiety  Alzheimer’s – Oral Health Considerations Cholinesterase inhibitors may cause sialorrhea, whereas antidepressants and antipsychotics are often associated with xerostomia Local anesthetics with adrenergic vasoconstrictors should be used with caution in AD patients taking tricyclic antidepressants due to potential risk of cardiovascular effects, such as hypertensive events or dysrhythmias  Step-up to medicine 5th edition Harrison’s Principles of Internal Medicine References & 20th edition NEJM further reading Amboss Thank You