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Peer 1
Abigail
The case study is discussing an eld
Please read the instructions:
Peer 1
Abigail
The case study is discussing an elderly man in his late 70s and about to enter his 80s, and he is experiencing some severe behavioral changes. Although the client had already had a dementia for 6 years, there are changes in his condition like behavioral changes that causes him to get hostile and aggressive with his wife at times. The client also has started to have visual hallucinations and is frightened when he sees them, and the client also has wandered out of his home a couple of times.
T.M’s new DSM 5-TR diagnosis would be Neurocognitive Disorder with Behavioral Disturbances or Dementia with Behavioral Changes.
The pharmacological measures necessary for this individual and his symptoms would be a drug that is a Cholinesterase Inhibitor, which can be a wide range of different drugs. The cholinesterase inhibitor would allow for there to be a decrease in the amount of acetylcholine that is breaking down into their components of acetate and choline., which in turn will slow the process of dementia and other neurogenerative diseases (Singh, 2023). Neurogenerative diseases are diseases that involve neuron loss like Alzheimer’s and Parkinson’s disease.
Slowing down the process of Acetylcholine breakdown, thus preventing limiting or decreasing the build-up of components acetate and choline. Acetylcholine is the neurotransmitter that is involved with memory, learning, attention and involuntary muscle movement (Cox et al., 2019). The prolonged duration of acetylcholine in both the peripheral and central nervous systems help to aid in neurodegenerative diseases, for example, improving memory loss. The drug of choice for the patient in this particular case study would be the drug Donepezil at 10 mg tablets per day, along with the medication Rexulti, which is also known as Brexipiprazole. The second medication Rexulti would be used to address the behavioral changes in the client. It can be any anti-psychotic medication that is goof for dementia in elderly patients.
Non-pharmacological treatment that can be tried with this patient can be a consistent support system, possible environmental changes that would and regular cues to assist in helping the client remember, for example, keeping the same exact routine with the same people, avoiding too much new and different stimuli and changes from the client’s day to day activities, try to keep ADL done at the same time each day, essentially adopting a routine that can be easily followed and remembered. It would also be beneficial for there to be someone with the client throughout the day providing cues, reminders, clear and simple instructions, when necessary, not necessarily a constant supervision but someone nearby that will be supervising, of course, depending on how severe the dementia and behavioral manifestations are.
Appropriateness of the treatment plan can be assessed by determining how the client has been behaving since the start of the treatment. For example, assessing the frequency is hostile outbursts before state of the treatment versus after, also the number of times the client fluctuates between calm and lucid behavior and aggressive behavior, the number of times, if any at all, of the client has experienced visual hallucinations. The cost of Donepezil 10 mg, a 30-day supply would be 22.62 cents at CVS Pharmacy with a free discount applied to the out-of-pocket cost to uninsured patients. Insured patients would more than likely have a zero-dollar co-pay. The Rexulti drug would run for well over 1000 dollars for only a 30-day supply, so an alternative drug that will be more affordable is Seroquel. Seroquel, or quetiapine, is a common drug use to calm dementia patients with behaviors. The cost for a 30-day supply of the generic of Seroquel, which is quetiapine, would be 22.62 (GoodRx, 2024).
Peer 2
Amber
TM’s health appears to be gradually deteriorating since his diagnosis of dementia six years ago. According to his wife, TM has been increasingly difficult to care for. He is having more frequent episodes of hostility and aggression, although she admits to never being assaulted by him. There is also a complaint of TM seeing people wandering around the house and that frightens him. Lastly, TM has been found wandering along the road by his home related to his increased confusion.
This patient is suffering from Major Neurocognitive disorder. According to American Psychiatric Association, (2013), diagnostic criteria that fit in with TM’s case study include: evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains. His condition is interfering with his cognitive abilities to function independently and requiring assistance with complex instrumental activities of day living. In addition to cognitive deficits, TM has been experiencing behavioral disturbances of psychotic symptoms of seeing people wandering around his house that scare him.
Cognitive impairment symptoms can range from mild to moderate. According to Carlat et al., (2022), there are three approved cholinesterase inhibitors. These drugs include: donepezil (Aricept), galantamine, and rivastigmine. Although the drug’s efficacy has been proven to be equally effective, there is more data collected on donepezil than the others, which is why it is recommended to start with this drug. The starting dosage is taking 5 mg daily by mouth for one month, then the dose increases by 10 mg and it is recommended to maintain this dose as long as the patient is responding well to the drug. If the patient’s condition worsens, then it is recommended to raise the dose up to 15 mg or 20 mg. Increase to 24 mg of galantamine if needed. In the case that the patient complains of vivid dreams, switch to immediate-release of the drug galantamine 24 mg oral intake. However, if the patient is experiencing secondary symptoms of agitation, aggression, wandering or psychosis, then the drug choices include prescribing antipsychotics, benzodiazepines, gabapentin, trazodone, or valproic acid.
Aricept has the longest track record and most extensively studied which naturally makes it a more predictable choice. The ‘off label’ uses include mild cognitive impairment and memory disorders. Due to TM suffering from moderate to severe dementia, the recommended starting dosage is 5 mg oral tablets QAM and increase the dose to 10 mg for four to six weeks. The dosage may increase to 23 mg QAM after at least three months if the patient is still declining. The efficacy for the drug is not curative, but it has proven to delay dementia progression by six to twelve months. According to Carlat et al., (2022), the drug is very affordable. Due to the patients condition, adherence to taking the drug may differ depending on if there is a responsible caretaker involved in the patients care. Unfortunately, dementia patients are notorious for either under dosing due to forgetting to take their medication, or over medication themselves due to not remembering if they already took their medication. This is why family or some sort of caretaker support is very important for dementia patients.
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