NURS 6521 Week 6 Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders Example Pharmacological Intervention for Major Neurocognitive Disorder Due to Alzheimer’s Disease

NURS 6521 Week 6 Assignment: Decision Tree for Neurologic and Musculoskeletal Disorders Example

Pharmacological Intervention for Major Neurocognitive Disorder Due to Alzheimer’s Disease

Alzheimer’s disease (AD), the most prevalent cause of cognitive decline, is severe enough to impede daily activities. It is a neurodegenerative condition that often affects persons over 65, affecting reasoning, memory, judgment, language, comprehension, and attention (Kumar & Tsao, 2019). Insidious onset and gradual impairment of cognition and behavioral functioning characterize Alzheimer’s disease (Cummings, 2021). Although many medicines may alleviate the symptoms of Alzheimer’s disease, the disease itself is incurable. This assignment examines pharmaceutical therapies for significant neurocognitive dysfunction with a presumptive Alzheimer’s diagnosis.

Case Summary

Mr. Akkad, a 76-year-old Iranian man, exhibits dementia symptoms such as forgetfulness, difficulty finding the right words, and behavioral changes. His family doctor found no organic cause for his conduct after normal blood and imaging tests. Mr. Akkad cooperated during the clinical interview but showed confabulation during the memory assessment. On the Mini-Mental State Test, he scored 18 out of 30, indicating mild dementia. During his mental status evaluation, he demonstrated poor eye contact, poor judgment, tangential speech, impaired insight, restricted affect, disorientation to time and event, and poor impulse control. The presumptive diagnosis is Alzheimer’s disease-related significant neurocognitive dysfunction.

Decision Point One

Treatment started with Razadyne (galantamine) 4 mg BID orally. Galantamine belongs to the group of medicines known as acetylcholinesterase inhibitors (Kalola & Nguyen, 2021). It is advised to start the medication at the lowest dosage possible and gradually increase it after determining its clinical efficacy and tolerability. The initial dosage for treatment is 4 mg twice daily. After at least four weeks, the dosage can be increased to 16 mg/day and then further escalated to a maximum of 24 mg/day (Kalola & Nguyen, 2021). When the patient with his son revisited the clinic in a month, the son reported that the medication had not improved his father. I keep noticing confabulation, and when I repeat the MMSE, the patient got 18 out of 30, with a deficiency in orientation, registration, attention, calculation, and recollection.

Decision Point Two

We stop Razadyne and start Exelon (rivastigmine) 1.5 mg orally BID. When the client comes to the facility in four weeks, his son notes he tolerates the medication appropriately but is still anxious that his father is not improving. Rivastigmine belongs to the cholinesterase inhibitor category of medications. (Patel & Gupta, 2023). According to studies, long-term rivastigmine treatment at the highest dosage results in the most substantial improvement in cognitive performance (Eldufani & Blaise, 2019). However, MMSE scores between 26 and 24, or 10 to 11, qualify for therapy.

Decision Three

We maintain the current Exelon dosage and reassess at the subsequent doctor visit. It may take months for cholinesterase inhibitors to show any stabilization in the degenerative course of Alzheimer’s disease. The Exelon dose should be increased to 3 mg orally BID as the client has no adverse effects. Exelon’s recommended dose is 12 mg, taken twice a day by mouth, spaced out to reduce the chance of side effects.

Perhaps now is not the right time to add Namenda. The optimal dose of Exelon should be reached before considering the addition of an NMDA receptor antagonist. Namenda dosage should begin at 5 mg orally daily and titrate up to 10 mg orally BID. The above 5 mg used orally daily should be divided into two doses, or an extended-release medication can be used instead (Kuns et al., 2020). The healthcare provider should emphasize that they need to assess the changes in the MMSE over months rather than weeks. If the MMSE has not improved after four weeks of treatment, that is not necessarily a cause for concern. Patients, families, and caregivers should be aware of the condition’s progressive nature and have reasonable expectations for treatment.

References

Cummings, J. (2021). The role of neuropsychiatric symptoms in research diagnostic criteria for neurodegenerative diseases. The American Journal of Geriatric Psychiatry, 29(4), 375–383. https://doi.org/10.1016/j.jagp.2020.07.011

Eldufani, J., & Blaise, G. (2019). The role of acetylcholinesteras