Neurological and Musculoskeletal Disorders Discussion Paper
Alzheimer’s disease (AD) is a terrible, degenerative illness in which clients’ cognitive ability and memory deteriorate over time. Alzheimer’s disease has risen to be among the most difficult diagnoses of the twenty-first century. Nevertheless, several risk variables for Alzheimer’s disease have been identified. The exact etiology of Alzheimer’s disease is unknown. Above 65 years of age, head traumas, a poor level of education, decreased rates of folic acid, massive amounts of homocysteine, estrogen/progastrin medication, and smoking are all potential risk factors for developing Alzheimer’s disease Neurological and Musculoskeletal Disorders Discussion Paper.
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The patient is an elderly Iranian man who was brought to the clinic by his son due to strange conduct. Another doctor examined him and ruled out an organic cause. All of his lab testing, and imaging of the skull, came back normal. Over the last 24 months, the son claims he has displayed strange behaviors. On subjective assessment, he seemed pleasant. In a mini-mental state assessment, he got an 18/ 30 in registration, orientation, attention, and calculation. His perception and judgment were impaired. He was impetuous, as indicated by his pacing up and down. He denies ideas of homicide and suicide. His diagnosis was significant neurocognitive disorder due to Alzheimer’s disease. At point one, the decision was made to provide Exelon (rivastigmine) at 1.5 mg twice a day, with a gradual rise to 3 mg over two weeks. After four weeks, the patient returned, accompanied by his son, who expressed dissatisfaction with the lack of progress. Neurological and Musculoskeletal Disorders Discussion Paper The father was still uninterested in religious activity. The patient’s confabulation was noticed, and an MMSE was administered, yielding a score of 18/30. At this time, the decision was made to increase Exelon to 4.5mg with the same frequency and method. The son stated that his father was tolerating the drug well after another four weeks, but that there had been no progress.
Based on these decisions, the client received the best care since the disease is permanent and the degeneration cannot be reversed by the drug. As a result, cholinesterase inhibitors must be used to stabilize symptoms. The patient had started actively engaging in religious services with his family. On the assumed trajectory of his disease, the patient and his family should be counseled. The MMSE should be examined for change after a few months, not weeks, according to Fish et al (2019). As a consequence, the MMSE result on the second visit should not be worrying. It is critical to optimize the Exelon dosage first (Vishwas et al., 2020).The outcomes I had hoped for with the patient have materialize. The patient’s symptoms were improving and he was tolerating the drug well. It was my hope that the patient would accomplish these achievements and be able to enjoy the rest of his life. Although some patients may see improvements in their symptoms, not everyone does, and it was encouraging to see this patient among those who do (Loi, et al., 2018).
Conclusion
A patient’s response to medicine in the case of Alzheimer’s Disease is not always predictable; little trial and error is required in the hopes of finding a prescription that works. At present moment, only a few drugs have been licensed for the treatment of Alzheimer’s disease. Patients and their families must be informed about the illness and treatment choices available to them, and the provider must be sensitive to the client’s cultural and religious diversity Neurological and Musculoskeletal Disorders Discussion Paper.
References
Fish, P. V., Steadman, D., Bayle, E. D., & Whiting, P. (2019). New approaches for the treatment of Alzheimer’s disease. Bioorganic & Medicinal Chemistry Letters, 29(2), 125-133. https://doi.org/10.1016/j.bmcl.2018.11.034
Loi, S. M., Eratne, D., Kelso, W., Velakoulis, D., & Looi, J. C. (2018). Alzheimer disease: Non-pharmacological and pharmacological management of cognition and neuropsychiatric symptoms. Australasian Psychiatry, 26(4), 358-365. https://doi.org/10.1177/1039856218766123
Vishwas, S., Awasthi, A., Corrie, L., Kumar Singh, S., & Gulati, M. (2020). Multiple target-based combination therapy of galantamine, memantine and lycopene for the possible treatment of Alzheimer’s disease. Medical Hypotheses, 143, 109879. https://doi.org/10.1016/j.mehy.2020.109879
Review the interactive media piece assigned by your Instructor. Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece. Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned. You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment. By Day 7 of Week 8 Write a 1- to 2-page summary paper that addresses the following: Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented Neurological and Musculoskeletal Disorders Discussion Paper.
Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources. What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources. Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples. case:Alzheimer’s Disease 76-year-old Iranian Male 76-year-old Iranian Male BACKGROUND Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal. According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.” Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation Neurological and Musculoskeletal Disorders Discussion Paper.
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SUBJECTIVE During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia. MENTAL STATUS EXAM Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When you asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation. Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive) RESOURCES § Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources. Decision Point One Select what you should do: Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks : Begin Aricept (donepezil) 5 mg orally at BEDTIME Begin Razadyne (galantamine) 4 mg orally BID http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html references should be peer-reviewed scholarly journals that are recent (2016-present). Include doi number Neurological and Musculoskeletal Disorders Discussion Paper