Oral health behaviour and socio-demographic profile of subjects with Alzheimer's disease as reported by their family caregivers

Objective: To evaluate the oral health care provided to subjects with Alzheimer's disease (AD) as reported by their family caregivers. Method: Structured interviews were performed with 56 Alzheimer caregivers from the Group of relatives and friends of subjects with AD of the Hospital de Clínicas de Porto Alegre. Spearman and Pearson correlations were performed. Results: The mean age of the subjects with AD was 76.09 (±7.76) years, 53.6% were female and 58.9% were in the advanced stage of AD. The mean number of teeth present was 11.66 (±10.94), and oral hygiene was performed 2.21 (±1.04) times/day. The provision of oral health care to subjects with AD was carried out by caregivers in 85.7%. Oral hygiene was provided by the caregivers to the subjects with AD with the aid of a toothbrush and/or gauze embedded with non‐fluoridated mouthwash in the majority of the cases. Complete dental prostheses were cleaned with the aid of mouthwashes instead of denture brushes by 44% of the subjects/caregivers. There was a significant association between the number of teeth in the subjects with AD and the number of oral hygiene procedures performed per day and current smoking. Conclusion: Oral health care planning for subjects with AD should take into account caregivers’ perceptions and knowledge about oral health and hygiene as caregivers represent the primary providers to these patients when the disease progresses from early to more advanced stages.     

The dental awareness and needs of a Parkinson's disease population

The dental awareness and needs of a population with Parkinson's disease were assessed by means of postal questionnaires sent to members of Parkinson's disease societies of Belfast and London. A total of 228 valid replies were received representing a response rate of 31%. Results showed that dental problems were reported often, xerostomia and burning sensation being at least twice that of the general population. Satisfaction with dental care was high although it was significantly reduced in those with loose dentures and burning sensation. The results of this study support a greater participation by dentists in the planning and provision of healthcare for sufferer of Parkinson's disease.     

The clinical evaluation of the oral status in Alzheimer-type dementia patients

doi: 10.1111/j.1741‐2358.2010.00401.x
The clinical evaluation of the oral status in Alzheimer‐type dementia patients Background: To evaluate the oral health status in patients with Alzheimer dementia (AD), and the association of the disease severity with the oral findings. Methods: The study was conducted on the study group (31 AD patients) and the control group (47 healthy volunteers) from the Neurology Department of the Institute. Cognitive status was evaluated with the MMSE scoring system. Oral parameters, such as decaying, missing, filled teeth (DMFT) index and teeth present (PT) were evaluated in the patients. Oral hygiene status, denture status and mucosal lesions, including denture‐induced stomatitis were also investigated. Results: The study was conducted on the study group (31 AD patients) and the control group (47 healthy volunteers). Tooth brushing and denture cleaning were irregular in 22 of 31 (70%) patients with AD. The ratio of the subjects who forgot to remove their denture during the night was significantly higher in the study group than in the control group (p < 0.001). In this study, decreased cognitive functions in AD patients have been demonstrated to result in a deterioration of denture care and increased denture‐related mucosal lesions. Conclusions: These findings were considered due to decreased denture care including the non‐removal of the denture in the night in the patients with decreased cognitive functions.     

口服硫酸链霉素对帕金森小鼠症状的改善及其对肠道菌群的影响

【目的】探讨硫酸链霉素对慢性帕金森病(Parkinson’sdisease,PD)小鼠症状的改善及肠道菌群的影响。【方法】将40只C57BL/6小鼠分为正常对照组、硫酸链霉素对照组、帕金森病模型组和硫酸链霉素干预帕金森病模型组。帕金森病模型组在实验的前5周采用1-甲基-4-苯基-1,2,3,6-四氢吡啶(1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine,25 mg/kg)和丙磺舒(250 mg/kg)联合诱导帕金森病模型;硫酸链霉素干预帕金森病模型组在模型构建的同时连续饮用链霉素水溶液(500μg/mL)至实验第8周末。综合运用转棒实验、爬杆实验、免疫组织化学、荧光定量PCR、高通量测序等多种实验方法,检测各组实验小鼠相关症状与指标。【结果】慢性PD模型小鼠与正常对照小鼠相比,表现出极显著的运动障碍(P0.01),脑黑质纹状体中多巴胺(Dopamine,DA)能神经元及其纤维极显著减少(P0.01),肠道出现显著的功能紊乱和炎症,同时肠道菌群结构发生了显著的变化:厚壁菌门/拟杆菌门(Firmicutes/Bacteroidetes,F/B)比值升高,疣微菌科(Ruminococcaceae)丰度极显著增加(P0.01),普雷沃氏菌科(Prevotellaceae)及Prevotellaceae_UCG-001丰度极显著降低(P0.01)。硫酸链霉素干预显著提高慢性PD小鼠的运动能力(P0.05),缓解脑黑质纹状体系统中DA能神经元及其纤维的减少(P0.05),改善肠道功能障碍和肠道炎症,同时可降低F/B的比值,显著降低Ruminococcaceae、理研菌科(Rikenellaceae)和乳杆菌科(Lactobacillaceae)的丰度,增加Prevotellaceae和Prevotellaceae_UCG-001的丰度。【结论】硫酸链霉素可改善PD小鼠相关症状,且影响了PD小鼠的肠道菌群结构。     

Oral hygiene and periodontal disease in Victorian nursing homes

doi: 10.1111/j.1741‐2358.2010.00448.x
Oral hygiene and periodontal disease in Victorian nursing homes Objective: To investigate oral hygiene and periodontal disease in residents of Victoria nursing homes. Background: The Australian population is ageing with a growing proportion of elderly Australians living in nursing homes. With declining edentulism rates, periodontal disease is becoming more prevalent in this population. Materials and methods: A total of 275 dentate residents from 31 Victorian nursing homes had a questionnaire and clinical examination using the Visual Plaque Index and a modified Community Periodontal Index. Results: Self‐reported oral hygiene habits of residents were poor, with less than one‐third of residents cleaning their teeth twice daily or more. Periodontal health was found to be extremely poor, and the prevalence of 4 mm+ periodontal pockets was 35.6%, with 10.2% having 6 mm+ pockets. Logistic regression found that age, gender, number of teeth present and oral hygiene were all strongly associated with the prevalence of 4 mm+ periodontal pockets. Conclusion: Poor oral hygiene and the presence of significant plaque and calculus were common findings in this study. Periodontal diseases are a significant problem for residents in nursing homes. Addressing this health issue will require improved training for carers and better access to appropriate dental services.     

Leucine‐rich repeat kinase 2 and Parkinson's disease

Leucine‐rich repeat kinase 2 (LRRK2) is a large multidomain protein that is expressed in many tissues and participates in numerous biological pathways. Mutations in LRRK2 are recognized as genetic risk factors for familial Parkinson's disease (PD) and may also represent causal factors in the more common sporadic form of PD. The structure of LRRK2 comprises a combination of GTPase, kinase, and scaffolding domains. This functional diversity, combined with a potentially central role in genetic and idiopathic PD motivates significant effort to further credential LRRK2 as a therapeutic target. Here, we review the current understanding for LRRK2 function in normal physiology and PD, with emphasis on insight gained from proteomic approaches.     

基于益生菌治疗帕金森病的研究进展

帕金森病是常见的神经退行性疾病,其发病原因至今尚未明确,目前的治疗方法价格昂贵、效果差且副作用大。帕金森病患者常见胃肠道功能障碍,帕金森病和肠道菌群之间的关联已得到实验证实,患者有望通过益生菌改善肠道菌群达到治疗的目的。工程益生菌的出现使得人们可以按照自己的意愿改造益生菌,提高其稳定性和靶向性,展现出其特有的应用潜力。本文将从益生菌治疗帕金森病的研究现状出发,阐述益生菌治疗帕金森病的可能机制,进一步分析工程益生菌治疗帕金森病的可行性,为该疾病的安全治疗提供新的思路。     

帕金森病整合医学治疗方法的探讨

本文对中老年常见的神经变性疾病帕金森病国内外发展概况、发病原因、发病机制进行了简要概述。对于帕金森病的临床治疗,本文提出整合医学治疗方法的理念,这种治疗包括常规一般临床药物治疗、肠道正常菌群和微生态制剂的微生态疗法的治疗、中医药单方和复方制剂的治疗,以及手术治疗(神经核毁损术,脑深部电刺激术)、干细胞治疗、基因编辑治疗等。整合当前最先进的理论和临床实践,提出了综合治疗帕金森病的方案。     

Involvement of aberrant regulation of epigenetic mechanisms in the pathogenesis of Parkinson's disease and epigenetic-based therapies

Parkinson's disease (PD) is known as a progressive neurodegenerative disorder associated with the reduction of dopamine-secreting neurons and the formation of Lewy bodies in the substantia nigra and basal ganglia routes. Aging, as well as environmental and genetic factors, are considered as disease risk factors that can make PD as a complex one. Epigenetics means studying heritable changes in gene expression or function, without altering the underlying DNA sequence. Multiple studies have shown the association of epigenetic variations with onset or progression of various types of diseases. DNA methylation, posttranslational modifications of histones and presence of microRNA (miRNA) are among epigenetic processes involved in regulating pathways related to the development of PD. Unlike genetic mutations, most epigenetic variations may be reversible or preventable. Therefore, the return of aberrant epigenetic events in different cells is a growing therapeutic approach to treatment or prevention. Currently, there are several methods for treating PD patients, the most important of which are drug therapies. However, detection of genes and epigenetic mechanisms involved in the disease can develop appropriate diagnosis and treatment of the disease before the onset of disabilities and resulting complications. The main purpose of this study was to review the most important epigenetic molecular mechanisms, epigenetic variations in PD, and epigenetic-based therapies.     

Analysis of socio-demographic and systemic health factors and the normative conditions of oral health care in a population of the Brazilian elderly

doi: 10.1111/j.1741‐2358.2010.00446.x
Analysis of socio‐demographic and systemic health factors and the normative conditions of oral health care in a population of the Brazilian elderly Objective: To investigate the association of socio‐demographic and systemic health factors according to the normative conditions of oral health care (dental caries, edentulism, periodontal disease and oral mucosal lesion) in elderly individuals. Material and methods: A cross‐sectional study was carried out in a group of elderly with access to community health care (n = 200). The normative conditions of oral health were then investigated according to the WHO and the SB Brazil criteria. Bivariate analyses were evaluated by the chi‐square test and Fisher’s exact test. An estimation of prevalence for the covariates was performed using Poisson’s regression models. Results: The prevalence of edentulism and oral mucosal lesions was detected in 58% and 21.5% of elderly patients, respectively. In the dentate subjects, the prevalence of dental caries and periodontal disease was 51.2% and 20.8%, respectively. Older men and individuals from lower‐income groups exhibited a higher prevalence of dental caries. Elderly women, illiterate individuals, and individuals over the age of 65 years exhibited a higher prevalence of edentulism. Elderly 60–64 years old and those who are employed had a significant association with periodontal disease. Conclusion: Socio‐demographic factors were associated with some notable oral diseases in the elderly.     

Glutathione metabolism and Parkinson's disease

It has been established that oxidative stress, defined as the condition in which the sum of free radicals in a cell exceeds the antioxidant capacity of the cell, contributes to the pathogenesis of Parkinson disease. Glutathione is a ubiquitous thiol tripeptide that acts alone or in concert with enzymes within cells to reduce superoxide radicals, hydroxyl radicals, and peroxynitrites. In this review, we examine the synthesis, metabolism, and functional interactions of glutathione and discuss how these relate to the protection of dopaminergic neurons from oxidative damage and its therapeutic potential in Parkinson disease.     

Oral health status and oral hygiene practices of patients with peptic ulcer and how these affect Helicobacter pylori eradication from the stomach

Background: Helicobacter pylori eradication from the oral cavity is more difficult than from the stomach. Thus, if the bacterium survives the antibacterial therapy in the oral cavity, it would be able to re‐infect the stomach within a few weeks. Since oral health status could correspond to oral infection with H. pylori, the aim of the study was to determine whether oral health and oral hygiene practices affect the efficacy of H. pylori eradication from the stomach. Material and Methods: The study was performed in 137 patients with peptic ulcer who had undergone a 7‐day course of eradication treatment with one of two sets of drugs: 1, omeprazole, amoxicillin, and tinidazole or 2, omeprazole, clarithromycin, and tinidazole. The efficacy of H. pylori eradication from the stomach was evaluated at the second gastroscopy 4 weeks after cessation of eradication therapy by means of two methods: rapid urease test and histology. The examination of natural dentition and prosthetic restorations as well as the assessment of hygienic procedures referring to natural dentition and dentures accompanied the second gastroscopy. Results: No association was found between the efficacy of H. pylori eradication from the stomach and the number of natural teeth, decayed teeth, use of dentures, debris index, or periodontal index. However, an association between eradication success and some oral hygiene procedures were noted. Unexpectedly, in patients treated with omeprazole, amoxicillin and tinidazole, the removal of dental prosthesis for the night and brushing the natural teeth twice a day or more reduced the efficacy of H. pylori eradication from the stomach. Conclusions: Oral health and oral hygiene practices seem unlikely to increase the efficacy of H. pylori eradication from the stomach.     

Oxidative stress in the aging substantia nigra and the etiology of Parkinson's disease

Parkinson's disease prevalence is rapidly increasing in an aging global population. With this increase comes exponentially rising social and economic costs, emphasizing the immediate need for effective disease‐modifying treatments. Motor dysfunction results from the loss of dopaminergic neurons in the substantia nigra pars compacta and depletion of dopamine in the nigrostriatal pathway. While a specific biochemical mechanism remains elusive, oxidative stress plays an undeniable role in a complex and progressive neurodegenerative cascade. This review will explore the molecular factors that contribute to the high steady‐state of oxidative stress in the healthy substantia nigra during aging, and how this chemical environment renders neurons susceptible to oxidative damage in Parkinson's disease. Contributing factors to oxidative stress during aging and as a pathogenic mechanism for Parkinson's disease will be discussed within the context of how and why therapeutic approaches targeting cellular redox activity in this disorder have, to date, yielded little therapeutic benefit. We present a contemporary perspective on the central biochemical contribution of redox imbalance to Parkinson's disease etiology and argue that improving our ability to accurately measure oxidative stress, dopaminergic neurotransmission and cell death pathways in vivo is crucial for both the development of new therapies and the identification of novel disease biomarkers.     

帕金森病认知功能障碍的相关因素及临床特点分析

目的:探讨帕金森病(PD)伴轻度认知功能障碍(PD-MCI)的相关因素及临床特征,找出帕金森病伴轻度认知功能障碍的预测因子。方法:参照运动障碍协会工作组推荐的帕金森病伴轻度认知功能障碍的诊断标准,用蒙特利尔认知功能评估量表(Mo C A)及帕金森病统一评定量表(Ⅰ~Ⅲ)对81例PD患者进行评估。结果:81例PD患者中47例为轻度认知功能障碍,占58%,23例无认知功能障碍,占28%;14%PD-MCI病人病程小于5年。PD-MCI组与帕金森病不伴有认知功能障碍(PD-NCI)组在文化程度、HY分期、每日左旋多巴等效剂量(LEDD)上差异有统计学意义(P0.05);视空间/执行功能、延迟记忆、注意力、语言、抽象能力认知域差异有统计学意义(P0.05);UPDRSⅢ、姿势不稳步态障碍(PIGD)差异有统计学意义(P0.05);Mo CA评分与年龄(r=-0.31,P0.05)、HY分期(r=-0.44,P0.05)、UPDRS-Ⅲ分数(r=-0.32,P0.05)、UPDRS-Ⅱ(r=-0.35,P0.05)、UPDRS-Ⅰ(r=-0.40,P0.05)、迟缓(r=-0.38,P0.05)、PIGD呈负相关(r=-0.31,P0.05),与教育程度呈正相关(r=0.30,P0.05)。纳入Mo CA评分为因变量,年龄、教育程度、HY分期、UPDRS-Ⅲ分数、UPDRS-Ⅱ分数、UPDRS-Ⅰ分数为自变量行多元线性回归分析,年龄(βcoefficients-0.06,P0.05)和HY分期(βcoefficients-0.80,P0.05)为帕金森病伴轻度认知功能障碍的预测因子;为观察UPDRSⅢ中亚项评分对认知功能的独立影响,单独纳入迟缓和PIGD评分为自变量,结果迟缓为帕金森病伴轻度认知功能障碍的预测因子(βcoefficients-0.12,P0.05)。结论:MCI是PD患者中发生率较高的一种非运动症状,以视空间/执行功能、延迟记忆、注意力、语言功能障碍为主。患者的认知功能和年龄、教育程度、疾病严重程度、运动障碍密切相关,特别是迟缓与姿势不稳/步态障碍。年龄、HY分期、迟缓为PD-MCI的预测因子。     

Discovery of catalytically active orthologues of the Parkinson's disease kinase PINK1: analysis of substrate specificity and impact of mutations

Missense mutations of the phosphatase and tensin homolog (PTEN)-induced kinase 1 (PINK1) gene cause autosomal-recessive Parkinson's disease. To date, little is known about the intrinsic catalytic properties of PINK1 since the human enzyme displays such low kinase activity in vitro. We have discovered that, in contrast to mammalian PINK1, insect orthologues of PINK1 we have investigated-namely Drosophila melanogaster (dPINK1), Tribolium castaneum (TcPINK1) and Pediculus humanus corporis (PhcPINK1)-are active as judged by their ability to phosphorylate the generic substrate myelin basic protein. We have exploited the most active orthologue, TcPINK1, to assess its substrate specificity and elaborated a peptide substrate (PINKtide, KKWIpYRRSPRRR) that can be employed to quantify PINK1 kinase activity. Analysis of PINKtide variants reveal that PINK1 phosphorylates serine or threonine, but not tyrosine, and we show that PINK1 exhibits a preference for a proline at the +1 position relative to the phosphorylation site. We have also, for the first time, been able to investigate the effect of Parkinson's disease-associated PINK1 missense mutations, and found that nearly all those located within the kinase domain, as well as the C-terminal non-catalytic region, markedly suppress kinase activity. This emphasizes the crucial importance of PINK1 kinase activity in preventing the development of Parkinson's disease. Our findings will aid future studies aimed at understanding how the activity of PINK1 is regulated and the identification of physiological substrates.     

An oral hygiene protocol improves oral health for patients in inpatient stroke rehabilitation

The objective

To determine whether a simple oral hygiene protocol improves the oral health of inpatients in stroke rehabilitation.

The background data discussing the present status of the field

Poor oral health can lead to serious complications, such as pneumonia. The comorbidities associated with stroke, such as dysphagia, hemiparesis and cognitive impairment, can further impede independent oral care. International stroke guidelines recommend routine oral care but stop short of detailing specific regimes.

Materials and methods

The oral health assessment tool (OHAT) was conducted by speech‐language pathologists with 100 patients with and without dysphagia in three metropolitan inpatient stroke rehabilitation facilities. A simple nurse‐led oral hygiene regime was then implemented with all participants, which included twice daily tooth brushing and mouth rinsing after lunch, and oral health was measured again one week later.

Results

Initially, dysphagia was negatively associated with OHAT scores, and independence for oral hygiene was positively associated with oral health. After one week of a simple oral hygiene regime, the OHAT scores available for 89 participants indicated an improvement on average for all participants. In particular, 59% of participants with dysphagia had an improvement of 1 or more points. None of the participants developed pneumonia.

Conclusion

A simple, inexpensive oral hygiene regime resulted in positive outcomes for patients with and without dysphagia in inpatient stroke rehabilitation settings. Oral health assessments and oral hygiene regimes that are simple to implement by the interdisciplinary team can be incorporated into standard stroke care with positive effect.     

Parkinson's disease as a result of aging

It is generally considered that Parkinson's disease is induced by specific agents that degenerate a clearly defined population of dopaminergic neurons. Data commented in this review suggest that this assumption is not as clear as is often thought and that aging may be critical for Parkinson's disease. Neurons degenerating in Parkinson's disease also degenerate in normal aging, and the different agents involved in the etiology of this illness are also involved in aging. Senescence is a wider phenomenon affecting cells all over the body, whereas Parkinson's disease seems to be restricted to certain brain centers and cell populations. However, reviewed data suggest that Parkinson's disease may be a local expression of aging on cell populations which, by their characteristics (high number of synaptic terminals and mitochondria, unmyelinated axons, etc.), are highly vulnerable to the agents promoting aging. The development of new knowledge about Parkinson's disease could be accelerated if the research on aging and Parkinson's disease were planned together, and the perspective provided by gerontology gains relevance in this field.