Alzheimers Disease Case Study

Alzheimers Disease Case Study

The patient, Mr. Akkad, is a 76-year-old Iranian male. He is brought by his son, who reports that the patient has been demonstrating strange thoughts and behaviors over the past two years. His symptoms are worsening. He began to lose interest in religious activities and became critical of everyone. It is reported that things he once considered serious are a source of amusement and ridicule. Mr. Akkad has been forgetting things and finds it difficult to pick the right words during a conversation. When the patient is subjected to a Mini-mental examination, he scores 18 out of 30, indicating moderate dementia. Deficits in registration, attention, orientation, recall, and calculation are identified. Mental status examination reveals that he is disoriented by time and events. Insight, judgment, and impulse control are also impaired. The diagnosis made is a neurocognitive disorder due to Alzheimer’s disease.

The first decision point is to begin Aricept (Donepezil) 5 mg orally at bedtime. The patient returns after four weeks, accompanied by his son. The son reports that no improvements have been observed. The Mini-mental examination results are unchanged. The second decision point is to increase Donepezil to 10 mg orally at bedtime. The patient and his son return after four weeks. The patient is tolerating the medication well. He has started to attend religious services with the family but is still amused by the things he once found serious. The third decision point is to continue Donepezil 10 mg orally at bedtime.

The decisions are supported by evidence-based literature. Aricept (Donepezil) is a cholinesterase inhibitor recommended for the treatment of all stages of Alzheimer’s disease. It is given at bedtime because it can cause bradycardia and syncope and may lead to falls hence injuries (Zhang & Gordon, 2018). Therefore, the first decision is to initiate Donepezil 5 mg orally at bedtime. The second decision is to increase the dose of Donepezil to 10 mg orally at bedtime. The dose of Donepezil is increased because the patient failed to respond to the initial dose. Furthermore, the patient did not demonstrate any adverse event indicating that the 5 mg dose was well tolerated. Therefore, a higher dose is indicated to control the symptoms of the disease.

The third decision is to continue Donepezil 10 mg daily at bedtime. The son reports that the patient has started attending religious services with the family. However, he is still amused by things he once considered serious. Treatment with Donepezil takes a long time before the deterioration is stabilized. Donepezil given at doses higher than 10 mg, can precipitate side effects (Adlimoghaddam et al., 2018). Increasing the dose to 15 and 20 mg per day would be inappropriate. The discontinuation of Donepezil is not warranted because the patient demonstrates a good tolerance to the dose. Alternatively, a combination therapy of Donepezil and Memantine, an NMDA receptor antagonist, is used (Li et al., 2019). Combination therapy enables low doses of both medications to be used hence avert side effects.

The decision points aimed to control the symptoms of Alzheimer’s disease. Donepezil is a reversible acetylcholinesterase inhibitor. It increases the concentrations of acetylcholine, which in turn enhances cholinergic neurotransmission (Ghosh et al., 2019). Although Alzheimer’s disease is incurable, enhancing cholinergic transmission by Donepezil leads to improving the signs and symptoms of the disease (Ghosh et al., 2019). Therefore, it was expected that Mr. Akkad would start attending religious services with family and start regarding things he considered serious as being important.

The first decision point of initiating 5 mg of Donepezil was to identify whether the patient responded to and tolerated the medication. The results revealed that he tolerated the medication, but it was not sufficient to improve his symptoms. The second decision point of increasing the dose to 10 mg was to check the tolerability of the dose and any improvement in the patient’s symptoms. The patient tolerated the dose, as evidenced by not reporting any side effects. The dose led to the improvement of the patient’s symptoms, evidenced by the reports that he attends religious services with the family. The third decision point of maintaining the dose to 10 mg daily at bedtime is aimed at further improving the symptoms of the patient. Alzheimer’s disease is incurable, and the treatment is lifelong. Management with Donepezil can take several months before the symptoms are stabilized. Furthermore, the improvement of the patient should be evaluated in months rather than weeks.

References

Adlimoghaddam, A., Neuendorff, M., Roy, B., & Albensi, B. C. (2018). A review of clinical treatment considerations of Donepezil in severe Alzheimer’s disease. CNS Neuroscience and Therapeutics, 24(10), 876–888. https://doi.org/10.1111/cns.13035

Ghosh, S., Jana, K., & Ganguly, B. (2019). Revealing the mechanistic pathway of cholinergic inhibition of Alzheimer’s disease by Donepezil: A metadynamics simulation study. Physical Chemistry Chemical Physics, 21(25), 13578–13589. https://doi.org/10.1039/c9cp02613d

Li, D. D., Zhang, Y. H., Zhang, W., & Zhao, P. (2019). Meta-analysis of randomized controlled trials on the efficacy and safety of Donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer’s disease. Frontiers in Neuroscience, 13(MAY). https://doi.org/10.3389/fnins.2019.00472

Zhang, N., & Gordon, M. L. (2018). Clinical efficacy and safety of Donepezil in the treatment of Alzheimer’s disease in chinese patients. Clinical Interventions in Aging, 13, 1963–1970. https://doi.org/10.2147/CIA.S159920

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

Alzheimers Disease Case Study

Case study (See link below)