What are neurodegenerative diseases?
In Alzheimer’s disease, there are signs of periodontal disease, denture stomatitis and caries. Ill-fitting and worn dentures and the presence of mucosal lesions (leukoplakia) are very common. Alzheimer’s medications may cause nausea and vomiting. However, inhalation pneumonia is possible.
In Parkinson’s disease, there is the loss of dopaminergic neurons in the substantia nigra. Tremor is one of the early signs and typically affect the hands but also lips and tongue. Bradykinesia is another symptom which affects the facial muscles. Orofacial pain can also lead to discomfort in the temporomandibular joint (TMJ), dental fractures, trauma of soft tissue, restoration detachment and lack of lack of salivary control. This makes prosthetic restorations quite difficult. Parkinson’s medications can induce xerostomia, thus worsening oral conditions. Furthermore, patients may have a mask – like appearance, stare, and hyperhidrosis.
In Huntington’s disease, the inheritance is autosomal dominant and there is a monogenic cause.
In Amyotrophic lateral sclerosis, there is motor neurone degeneration.
What is dementia and how common is it?
Dementia is a clinical syndrome characterised by progressive deterioration in multiple cognitive domains. It is frequently associated with behavioural disturbances.
Risk factor for dementia is age. However, this is after 65 years. At age 65 years, less than 5% of people will have dementia. However, by 80 years old, 15 – 20% will suffer. The global incidence is around 7.5 per 1000 people.
Which neurodegenerative diseases lead to dementia?
The most common cause of dementia is Alzheimer’s disease. This affects 60 -80% of the population with dementia. The next commonest is vascular dementia, which affects 10 – 20% of those with dementia. Approximately half of the patients with vascular dementia.
Dementia with Lewy bodies, as well as alcohol related dementia, are less common.
How exactly does dementia develop?
The current theories remain that dementia is due to misfolded or unfolded proteins. Overtime, these proteins aggregate and cause protein diseases.
The most common types of proteins implicated are:
· Amyloid and tau in Alzheimer’s disease
· Alpha – synuclein in dementia with Lewy bodies
· Tau, TDP43 or FUS in Frontotemporal dementia
What needs do patients with dementia have?
Dementia management needs to focus on the patient, carer, and their local medical officer with involvement of service providers. Education and support of carers is essential. Sometimes, palliative care is needed for
What are the main classes of drugs for patients with dementia?
For patients with Alzheimer’s disease in Australia, there are two types of drugs.
Cholinesterase inhibitors for mild to moderate Alzheimer’s Disease, such as donepezil, galantamine, and rivastigmine.
NMDA antagonists for moderate to severe Alzheimer’s disease, such as Memantine.
The drugs offer symptomatic treatment only. They do not prevent neurodegeneration. In severe cases, only one in six patients will respond to drug therapy.
Are there genetic risk factors for dementia?
Yes, a dominantly inherited dementia with an onset age between 30 and 60 is known. This disease occurs when one copy of the gene is expressed. There are three genes: the amyloid protein precursor gene on chromosome 21, the presenilin – 1 gene on chromosome 14 and the presenilin – 2 gene on chromosome 1. This is rare but counselling can be done for at risk families.
Are there environmental and other risk factors for dementia?
The link between aluminium and Alzheimer’s dementia is very weak.
Higher levels of education seem to be negatively correlated to dementia.
Diets rich in fish, fruit and vegetables have also been linked with a lower risk of dementia.
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