ABSTRACT
The emerging domain of epigenetics in molecular medicine finds application for a variety of patient populations. Here, we present fundamental neuroendocrine immune evidence obtained in patients with senile dementia of the Alzheimer's type (sDAT), and discuss the implications of these data from the viewpoint of translational epigenetics of Alzheimer's disease. We followed 18 subjects with mild sDAT treated with acetylcholinesterase inhibitors, and 10 control subjects matched for age in a repeated measure design every six months for 18 months. We monitored psychosocial profile (Mini-Mental State Examination, Functional Assessment Staging, Independence in Activities of Daily Living, Depression, Profile of Moods States) in parallel to immunophenotypic parameters of T cell subpopulations by flow cytometry. Based on change in the mini-mental state score at entry and at 18 months, patients with sDAT were assigned to a "fast progression" (delta greater than 2 points) or to a "slow progression" group (delta less than or equal to 2 points). The change in circulating activated T cells (CD3+Dr+) with time in patients with sDAT was significantly inversely correlated with the change in time in natural killer (NK) cytotoxic activity to cortisol modulation in these patients, which was greater in patients with fast progression, compared to slow progression sDAT. These data indicate underlying neuroendocrine immune processes during progression of sDAT. Our observations suggest that psychoimmune measures such as those we have monitored in this study provide relevant information about the evolving physiological modulation in patients with sDAT during progression of Alzheimer's disease, and point to new or improved translational epigenetic treatment interventions.
ABSTRACT
This paper presents the novel domain of evidence-based research in the context of treating the dental needs of patients with special needs. A contrast is made between evidence-based dentistry and traditional dentistry, which is based on the evidence obtained by the dentist, with respect to the needs and the wants of the patient, and from the pertinent and accessible literature. By contrast, evidence-based dentistry is focused on integrating traditional dentistry with "the best available" research evidence. The aim of evidence-based dentistry is to improve clinical decision-making by its reliance on a critical analysis of the entire body of the published pertinent literature. It is a system of information management, and a system of data integration that assist clinicians in the process of meshing systemic clinical expertise, evidence provided by the patient, and the best literature evidence to enhance treatment outcomes. Evidence-based dentistry emphasizes rigorous analysis of evidence from clinical research, as the basis of sound dental practice, while discouraging intuitive and unsystematic approaches and promoting the systematic analysis and appraisal of the literature to determine the best treatment alternatives. In the case of patients with special needs, it is critical whether the dentist practices traditional dentistry or evidence-based dentistry to evaluate whether or not the patient is capable of expressing his or her needs/wants, unless, as in the more severe cases, he/she is accompanied by the caregiver. The purpose of this paper is to demonstrate the use of a simple in-house questionnaire for evaluating the patient's ability to tell the dentist his or her needs and wants accurately. In this context, the paper examines the dental needs of patients with dementia of the Alzheimer's type, DAT.