Case Study: An Elderly Iranian Man with Alzheimers Disease – NURS 6521
Neurologic and Musculoskeletal Disorders and Opioids Example 1
The patient in this case study is Mr. Akkad, a 76-year-old Iranian male brought to the clinic by his eldest son due to strange behavior. Mr. Akkad’s son reported that his father’s personality had changed, and he had been demonstrating unusual thoughts and behaviors for the past two years. Additionally, during the clinical interview, Mr. Akkad experienced memory loss, difficulty finding the right words, and exhibited confabulation.
He scored 18 out of 30 on the Mini-Mental State Exam, indicating moderate dementia. In Decision Point One, it was decided to begin treatment with Aricept (donepezil) at a dose of 5 mg orally at bedtime. However, when Mr. Akkad returned to the clinic after four weeks, there was no improvement in his condition. Confabulation persisted, and he scored the same on the MMSE.
In Decision Point Two, the dosage of Aricept was increased to 10 mg orally at bedtime. Four weeks later, Mr. Akkad’s son reported that his father was tolerating the medication well but showed no significant improvement. Although Mr. Akkad started attending religious services with the family, his disinhibited behaviors and easily amused nature persisted. In Decision Point Three, it was decided to continue Aricept at 10 mg orally at bedtime and gradually increase the dosage. The dosage was increased to 15 mg orally at bedtime for six weeks and then further increased to 20 mg orally at bedtime. There is no information available regarding the outcome of this decision.
Aricept (donepezil) is a commonly prescribed medication for Alzheimer’s disease, aiming to improve cognitive symptoms (Larkin, 2022). The initial decision to start Aricept at a dose of 5 mg orally at bedtime aligns with standard practice. Increasing the dosage to 10 mg orally at bedtime is also a reasonable step, as it is a common dosage adjustment for patients who do not show significant improvement with the lower dose. However, it is challenging to make a definitive judgment without more information on the patient’s specific clinical profile, response to treatment, and side effects.
Additionally, the case study does not provide information on the subsequent decision to continue Aricept at the current dosage or to switch to Namenda (memantine). To make a comprehensive evaluation of the decisions made, it is crucial to consider the patient’s individual characteristics, clinical guidelines, and the broader body of evidence-based literature (Larkin, 2022). Consulting professional medical resources, such as clinical practice guidelines and peer-reviewed literature, would be beneficial in assessing the appropriateness of the decisions made in this case.
The decisions recommended for the patient case study were aimed at managing the symptoms of a major neurocognitive disorder, presumptively due to Alzheimer’s disease. The primary goal was to potentially slow down the progression of cognitive decline, improve cognitive function, and enhance the patient’s overall quality of life. Aricept (donepezil) is one of the commonly prescribed medications for Alzheimer’s disease, targeting the cholinergic system and aiming to enhance cognitive function. Studies have shown its potential benefits in improving cognition, global function, and activities of daily living in patients with Alzheimer’s disease (Choi et al., 2021).
The decision to increase the dosage of Aricept from 5 mg to 10 mg orally at bedtime was based on the notion that higher doses may offer greater clinical benefits. Some studies have suggested that higher doses of donepezil may lead to additional cognitive benefits in patients with Alzheimer’s disease (Larkin, 2022). However, it is important to note that the response to donepezil can vary among individuals, and decisions regarding dosage adjustments should be made based on careful clinical evaluation and consideration of potential side effects.
The expected outcomes of Decision Points One and Two in the exercise were to see improvements in Mr. Akkad’s condition, including a reduction in disinhibited behaviors, increased interest in religious activities, and improvements in cognitive deficits.
However, the actual results did not align with these expectations. Despite the medication, Mr. Akkad’s symptoms persisted, including disinhibited behaviors, disinterest in religious activities, and confabulation. This suggests that the initial treatment approach with Aricept did not yield the desired results. Further adjustments or alternative treatment options may be necessary to address Mr. Akkad’s ongoing symptoms (Rosenthal & Burchum, 2021).
References
Choi, G. W., Lee, S., Kang, D. W., Kim, J. H., & Cho, H. Y. (2021). Long-acting injectable donepezil microspheres: Formulation development and evaluation. Journal of Controlled Release, 340, 72-86. https://doi.org/10.1016/j.jconrel.2021.10.022
Larkin, H. D. (2022). First donepezil transdermal patch approved for Alzheimer disease. JAMA, 327(17), 1642-1642. https://doi.org/10.1001/jama.2022.6662
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.