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Running head: ALZHEIMER’S DISEASE 1
Alzheimer’s Disease
Name
School
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ALZHEIMER’S DISEASE 2
Alzheimer's disease is a neurodegenerative disease that results in a progressive loss in
brain function and is the most common cause of dementia. The neurodegenerative disease is
characterized by symptoms such as confusion, disinhibition, forgetfulness and cognitive
dysfunction in patients.
In Mr. Akkad's case, the symptoms of the condition are characterized by increased
forgetfulness, loss of interest in activities that interested him, deficits in orientation, recall,
attention, and registration.
Decision point 1
The available treatments for the client included Exelon twice daily 1.5 mg oral with
an increase to 3 mg in 2 weeks, Aricept 5 mg oral at bedtime or Razadyne 4mg twice daily
dosing orally. I chose to start the patient on Aricept 5mg dosage once daily. The reason for
choosing Aricept was that the drug is approved by the Food and Drug Agency (FDA) for the
management of Alzheimer’s disease and has been proven to be efficacious in reducing
symptoms associated with the neurodegenerative symptoms in Alzheimer’s disease
(Cummings et al., 2015). Exelon is also approved for the management of Alzheimer’s
disease, and from studies has similar efficacy levels as Aricept, I chose to start the patient on
Aricept however due to the dosage times for the drugs as Aricept is once daily while Exelon
is twice daily (Cummings et al., 2015). Once daily dosage would be easier for the patient
factoring the onset of dementia to ensure adherence is initiated and sustained. Aricept is also
dosed at bedtime hence reduces the impact of the drugs side effects on the patient during the
day. Razadyne although also approved by the FDA, has been proven to be less efficacious
compared to Aricept and Exelon in dementia and is associated with higher side effects risks
(Di Santo et al., 2013).
The goal of starting the patient on Aricept 5 mg was to assess the patient’s tolerability
to the medication. The medication was administered at bedtime to reduce the impact of the
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ALZHEIMER’S DISEASE 3
medication’s side effects. The side effects of the cholinesterase inhibitors are dose-related
hence the starting low dosage of 5 mg was to ensure tolerability prior to gradually increasing
the dosage (Cummings et al., 2015).
The patient outcomes were as expected, the patient tolerated the medication dosage
as prescribed and there was no therapeutic outcome following the administration of the drug
at the dosage of 5 mg. The therapeutic outcomes of Aricept are dosage related to higher doses
likely to produce better improvements in symptoms but also increased risk of side effects
(Cummings et al., 2015). The therapeutic outcomes from treatment for dementia in
Alzheimer’s may take long as the drug effects may not be experienced immediately hence the
reported symptoms persisted on the visit.
Decision 2
The treatment options that were available for the patient were an increase of Aricept
to 10 mg oral at bedtime, discontinue Aricept and start on Razadyne extended release 24 mg
orally or to discontinue Aricept and begin Namenda extended release 28 mg orally daily. I
chose to increase the dosage of Aricept to 10 mg daily oral dosage at bedtime. The efficacy of
Aricept is dose-related, an increase in the dosage for the patient from 5 mg to 10 mg is likely
to result in improvement in some of the patient's symptoms (Birks & Harvey, 2018). The
patient has responded well to the initial dosage of Aricept with no indication of lack of
tolerability hence no indication to stop Aricept and introduce new medication either
Razadyne or Namenda.
The aim of the increase in the dosage was to achieve a cognitive improvement in the
patient with treatment while still maintaining the dose tolerability. Aricept 10 mg is the
maximal dosage at which there is a limited risk of developing side effects.
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ALZHEIMER’S DISEASE 4
The outcomes from the treatment were expected, the patient showed an improvement
in his symptoms by accepting to go to attend religious functions. Although he still has
persistent symptoms it is important to have the patient and the family members to understand
that the medication would have no effect on the neurodegenerative disease that has already
occurred hence not all the symptoms can be catered for by the treatment and the patient will
continue to need their support and care. The persistent MMSE scores are not of concern as
the scores should be evaluated after months of treatment.
Decision 3
The available options for the management of the patient were, a continuation of
Aricept 10 mg at bedtime, increase of the dosage to 15 mg at bedtime for 6 weeks then to 20
mg at bedtime, discontinue Aricept and start Namenda 5 mg. I chose to continue with 10 mg
dosage of Aricept at bedtime. The reason being the patient has shown tolerance to the dosage
and there has been a therapeutic improvement in the patient, more improvement in the patient
is expected with continued treatment. Increasing the dosage to 15 and later 20 mg may lead to
an improvement in the patient's symptoms, however, it increases the risk of developing dose-
related side effects which could lead to non-adherence. The patient has responded positively
to Aricept 10 mg hence there is no indication for the stoppage of the medication to introduce
Namenda 5mg into his treatment.
The goal of the treatment is to continue monitoring the patient's response to the
dosage over time. The symptoms of disinhibition may improve with continued use of the
medication. Counseling on the progress of Alzheimer and the irreversibility of the
neurodegenerative process will be critical to improving patient and family coping and support
of care.
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ALZHEIMER’S DISEASE 5
Conclusion
The care for the patient should be done in a culturally sensitive approach. The patient
is an immigrant from Iran whose cultural and religious practices may differ as well as having
a possible lower health literacy. It is important to provide family-centered care to the patient
as he will require family support for a successful treatment outcome to be achieved.
Adherence to ethical practices in care such as beneficence is critical to ensure that all
interventions for the patient are done to benefit the patient or lead to improved patient
outcomes.
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ALZHEIMER’S DISEASE 6
References
Birks, J., & Harvey, R. (2018). Donepezil for dementia due to Alzheimer's disease. Cochrane
Database of Systematic Reviews. doi: 10.1002/14651858.cd001190.pub3
Cummings, J., Isaacson, R., Schmitt, F., & Velting, D. (2015). A practical algorithm for
managing Alzheimer's disease: what, when, and why? Annals of Clinical and
Translational Neurology, 2(3), 307-323. doi: 10.1002/acn3.166
Di Santo, S., Prinelli, F., Adorni, F., Caltagirone, C., & Musicco, M. (2013). A Meta-
Analysis of the Efficacy of Donepezil, Rivastigmine, Galantamine, and Memantine in
Relation to Severity of Alzheimer's Disease. Journal of Alzheimer's Disease, 35(2),
349-361. doi: 10.3233/jad-122140

Unformatted Attachment Preview

Running head: ALZHEIMER’S DISEASE Alzheimer’s Disease Name School 1 ALZHEIMER’S DISEASE 2 Alzheimer's disease is a neurodegenerative disease that results in a progressive loss in brain function and is the most common cause of dementia. The neurodegenerative disease is characterized by symptoms such as confusion, disinhibition, forgetfulness and cognitive dysfunction in patients. In Mr. Akkad's case, the symptoms of the condition are characterized by increased forgetfulness, loss of interest in activities that interested him, deficits in orientation, recall, attention, and registration. Decision point 1 The available treatments for the client included Exelon twice daily 1.5 mg oral with an increase to 3 mg in 2 weeks, Aricept 5 mg oral at bedtime or Razadyne 4mg twice daily dosing orally. I chose to start the patient on Aricept 5mg dosage once daily. The reason for choosing Aricept was that the drug is approved by the Food and Drug Agency (FDA) for the management of Alzheimer’s disease and has been proven to be efficacious in reducing symptoms associated with the neurodegenerative symptoms in Alzheimer’s disease (Cummings et al., 2015). Exelon is also approved for the management of Alzheimer’s disease, and from studies has similar efficacy levels as Aricept, I chose to start the patient on Aricept however due to the dosage times for the drugs as Aricept is once daily while Exelon is twice daily (Cummings et al., 2015). Once daily dosage would be easier for the patient factoring the onset of dementia to ensure adherence is initiated and sustained. Aricept is also dosed at bedtime hence reduces the impact of the drugs side effects on the patient during the day. Razadyne although also approved by the FDA, has been proven to be less efficacious compared to Aricept and Exelon in dementia and is associated with higher side effects risks (Di Santo et al., 2013). The goal of starting the patient on Aricept 5 mg was to assess the patient’s tolerability to the medication. The medication was administered at bedtime to reduce the impact of the ALZHEIMER’S DISEASE 3 medication’s side effects. The side effects of the cholinesterase inhibitors are dose-related hence the starting low dosage of 5 mg was to ensure tolerability prior to gradually increasing the dosage (Cummings et al., 2015). The patient outcomes were as expected, the patient tolerated the medication dosage as prescribed and there was no therapeutic outcome following the administration of the drug at the dosage of 5 mg. The therapeutic outcomes of Aricept are dosage related to higher doses likely to produce better improvements in symptoms but also increased risk of side effects (Cummings et al., 2015). The therapeutic outcomes from treatment for dementia in Alzheimer’s may take long as the drug effects may not be experienced immediately hence the reported symptoms persisted on the visit. Decision 2 The treatment options that were available for the patient were an increase of Aricept to 10 mg oral at bedtime, discontinue Aricept and start on Razadyne extended release 24 mg orally or to discontinue Aricept and begin Namenda extended release 28 mg orally daily. I chose to increase the dosage of Aricept to 10 mg daily oral dosage at bedtime. The efficacy of Aricept is dose-related, an increase in the dosage for the patient from 5 mg to 10 mg is likely to result in improvement in some of the patient's symptoms (Birks & Harvey, 2018). The patient has responded well to the initial dosage of Aricept with no indication of lack of tolerability hence no indication to stop Aricept and introduce new medication either Razadyne or Namenda. The aim of the increase in the dosage was to achieve a cognitive improvement in the patient with treatment while still maintaining the dose tolerability. Aricept 10 mg is the maximal dosage at which there is a limited risk of developing side effects. ALZHEIMER’S DISEASE 4 The outcomes from the treatment were expected, the patient showed an improvement in his symptoms by accepting to go to attend religious functions. Although he still has persistent symptoms it is important to have the patient and the family members to understand that the medication would have no effect on the neurodegenerative disease that has already occurred hence not all the symptoms can be catered for by the treatment and the patient will continue to need their support and care. The persistent MMSE scores are not of concern as the scores should be evaluated after months of treatment. Decision 3 The available options for the management of the patient were, a continuation of Aricept 10 mg at bedtime, increase of the dosage to 15 mg at bedtime for 6 weeks then to 20 mg at bedtime, discontinue Aricept and start Namenda 5 mg. I chose to continue with 10 mg dosage of Aricept at bedtime. The reason being the patient has shown tolerance to the dosage and there has been a therapeutic improvement in the patient, more improvement in the patient is expected with continued treatment. Increasing the dosage to 15 and later 20 mg may lead to an improvement in the patient's symptoms, however, it increases the risk of developing doserelated side effects which could lead to non-adherence. The patient has responded positively to Aricept 10 mg hence there is no indication for the stoppage of the medication to introduce Namenda 5mg into his treatment. The goal of the treatment is to continue monitoring the patient's response to the dosage over time. The symptoms of disinhibition may improve with continued use of the medication. Counseling on the progress of Alzheimer and the irreversibility of the neurodegenerative process will be critical to improving patient and family coping and support of care. ALZHEIMER’S DISEASE 5 Conclusion The care for the patient should be done in a culturally sensitive approach. The patient is an immigrant from Iran whose cultural and religious practices may differ as well as having a possible lower health literacy. It is important to provide family-centered care to the patient as he will require family support for a successful treatment outcome to be achieved. Adherence to ethical practices in care such as beneficence is critical to ensure that all interventions for the patient are done to benefit the patient or lead to improved patient outcomes. ALZHEIMER’S DISEASE 6 References Birks, J., & Harvey, R. (2018). Donepezil for dementia due to Alzheimer's disease. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.cd001190.pub3 Cummings, J., Isaacson, R., Schmitt, F., & Velting, D. (2015). A practical algorithm for managing Alzheimer's disease: what, when, and why? Annals of Clinical and Translational Neurology, 2(3), 307-323. doi: 10.1002/acn3.166 Di Santo, S., Prinelli, F., Adorni, F., Caltagirone, C., & Musicco, M. (2013). A MetaAnalysis of the Efficacy of Donepezil, Rivastigmine, Galantamine, and Memantine in Relation to Severity of Alzheimer's Disease. Journal of Alzheimer's Disease, 35(2), 349-361. doi: 10.3233/jad-122140 Name: Description: ...
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