Alzheimer’s Disease Assignment Paper
Mr. Akkad: Alzheimer’s Disease
The client is a 76-year-old man who presented with the son with complaints about some strange behaviors and thoughts, which are deteriorating. The son reported that the client’s personality had changed, he had lost interest in religious activities, stopped taking things seriously, and criticized everyone. The client also manifested forgetfulness and speech problems. MSE indicated deficits in attention and calculation, memory, orientation, and registration. His MSE score was 18/30. His diagnosis is a neurocognitive disorder due to Alzheimer’s disease (presumptive). The first decision for the client was to prescribe Exelon (rivastigmine) 1.5 mg, with the recommended dose increment (3 mg orally BID in 2 weeks). The second decision was to increase rivastigmine dose to 4.5 mg while the third decision is to increase Exelon dose to 6 mg orally BID. Alzheimer’s Disease Assignment Paper
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The recommended decisions were supported by evidence-based literature. This is because evidence shows that rivastigmine is effective in treating Alzheimer’s disease. Rivastigmine works by increasing the level of acetylcholine within the brain and thus improves the cholinergic function; this improves the cognitive symptoms present in Alzheimer’s disease (Su et al., 2015). The decisions to increase the dose of rivastigmine in order to increase the efficacy of the medication are evidence-based because studies show that higher doses of rivastigmine avail more acetylcholine in the brain and thus increases the efficacy of the medication to improve the symptoms (Sadowsky et al., 2015).
With these decisions, the expectations were that the behavioral problems and cognitive deficits present in this client would improve. This is because of the efficacy of rivastigmine in improving cholinergic function and thus improves the cognitive deficits present in Alzheimer’s disease (Birks et al, 2015). When the dose of rivastigmine 1.5 mg was administered, the client did not manifest any symptom improvement and hence the other decisions were to increase the dose to 4.5 mg and then to 6 mg in order to increase the efficacy of the medication. When the rivastigmine 1.5 mg was administered, the symptoms did not improve and hence the second and third decisions were to increase the dose. With an increased dose, it was expected that the client would manifest symptom improvement through improved cognitive symptoms and behavioral symptoms. Just as expected, when the dose was increased, the symptom manifested symptom improvement such as by starting to attend religious activities with the family. The improvement of symptoms is attributable to the increased efficacy of the higher dose of rivastigmine (Birks et al., 2016). The client did not experience any side effects even with the increased dose.Alzheimer’s Disease Assignment Paper
References
Birks J, Chong L & Grimley J. (2015). Rivastigmine for Alzheimer’s disease. Cochrane Database of Systematic Reviews, 9(2).
Birks J, Chong L & Grimley J. (2016). Rivastigmine for Alzheimer’s disease. Cochrane Database of Systematic Reviews. Cochrane Dementia and Cognitive Improvement Group.
Sadowsky C, Micca J, Grossberg G & Velting D. (2014). Rivastigmine From Capsules to Patch: Therapeutic Advances in the Management of Alzheimer’s Disease and Parkinson’s Disease Dementia. Prim Care Companion CNS Disord, 16(5).
Su J, Liu Y, Liu Y & Ren L. (2015). Long-term effectiveness of rivastigmine patch or capsule for mild-to-severe Alzheimer’s disease: a meta-analysis. Expert Rev Neurother, 15(9),1093–1103.
Alzheimer’s Disease Assignment Paper