Scenario
In the presented case study, Mr. Akkad, a 76-year-old male, comes to the office with his son. The son explains that his father has shown signs of strange behavior and has been changing in the past two years. Mr. Akkad has lost interest in the religious activities that the family always participated in together.
Furthermore, his attitude became more critical, and he began treating serious topics with ridicule. Apart from these changes, Mr. Akkad also began experiencing memory problems and speaking difficulties, which are evident in tangents, forgetfulness, or trouble finding the right words. The family physician finds no organic basis for these changes, and all diagnostic and laboratory tests appear normal. Upon performing a Mini-Mental State Exam, a score of 18 out of 30 indicates that the patient has moderate dementia (Dementia Care Central, 2022). The potential diagnosis is Alzheimer’s disease with major neurocognitive disorder.
Assessment
The assessment of dementia is a challenging process, as the patient’s factors and underlying conditions may impact their cognition. Typical results of laboratory and diagnostic tests performed previously eliminate the diagnoses based on physical damage – internal bleeding, tumors, stroke, and similar conditions – or hormonal changes, such as an underactive thyroid gland. Additionally, the test with a relatively high score supports the preliminary diagnosis of moderate dementia. Based on these factors, it is possible to start treatment of Alzheimer’s disease and see whether certain medications improve the patient’s cognitive function.
Treatment Decisions
Pharmacology
The three key decisions regarding the patient’s treatment include pharmacology, therapy, and lifestyle modifications. First, a standard drug treatment used for mild to moderate dementia is Aricept (donepezil) (Rosenthal & Burchum, 2021). The patient does not have any apparent comorbidities that may affect his ability to take this medication. Nevertheless, the patient should start with a small dose of 5 mg orally, once daily, before bed (Rosenthal & Burchum, 2021). After 4 to 6 weeks of taking Aricept at this dosage, the dose should be increased to 10 mg (Rosenthal & Burchum, 2021). It is a standard dose for treating mild or moderate dementia that should not be increased in the future unless the patient starts exhibiting severe cognitive impairment.
Occupational Therapy
The second decision for Mr. Akkad is to start occupational therapy. This approach can help patients prevent accidents, manage emotional responses, and prepare them for instances where they are self-reliant (Kudlicka et al., 2019).
Lifestyle Changes
Finally, some lifestyle changes can be recommended for Mr. Akkad and his family. For example, they may participate in group activities but choose places that are quiet and calm to allow Mr. Akkad to maintain focus. If Mr. Akkad operates a vehicle, a discussion about safety and the possibility of not driving should be held with the patient by his family members.
Evidence-Based Rationale for Treatment
The decisions outlined above are supported by scholarly evidence. First, the proposed medical treatment with Aricept is part of a standard pharmacological approach for Alzheimer’s disease (Rosenthal & Burchum, 2021). A gradual increase in dosage is necessary to reduce the risk of side effects, such as nausea and diarrhea (Rosenthal & Burchum, 2021). The patient should start at a lower dose and continue it for at least one month before making any changes.
Next, occupational therapy is a component of treatment that supports cognitive health (Kudlicka et al., 2019). It is often recommended that individuals with mild to moderate dementia increase their resilience and receive support with daily activities (Kudlicka et al., 2019). Ultimately, family support is crucial for Mr. Akkad, as his memory issues may lead to frustration or confusion (Hsieh et al., 2022). Thus, each solution presented is supported by scholarly evidence relevant to the patient’s case.
Expected Outcomes
The selected decisions target specific areas of the patient’s well-being and support them in their daily life. The decision to initiate medication is made to reverse the inhibition of AChE and help the patient improve his memory (Rosenthal & Burchum, 2021). Furthermore, this cholinesterase inhibitor can contribute to Mr. Akkad’s decision-making.
Similarly, occupational therapy was chosen to help Mr. Akkad develop better habits and support his participation in daily activities with his family. It is apparent that religious practices are essential for the family members, and his sudden changes in behavior produce adverse outcomes for his closest relatives. Occupational therapy can help patients manage behavioral changes. It is expected that occupational therapy will lead to improved safety and better mood regulation for Mr. Akkad. The changes in the patient’s lifestyle and the participation of his family members are expected to bring the same positive results, improving his routine and lowering the risk of confusion or negative emotions.
Outcome Evaluation
When reviewing patients with cognitive impairment and such conditions as Alzheimer’s disease and dementia, it is vital to remember that treatments are not cures and that improvement is often slow. Thus, one’s goals should not be excessive and focus on stabilizing the patient’s condition. The present expectations do not differ significantly from the results shown in the case study, as the aims for Mr. Akkad are focused on slow improvements and gradual lifestyle changes. Cholinesterase inhibitors work slowly and may not show results within the first months of taking them (Rosenthal & Burchum, 2021). The patient should continue his treatment and visit the office every one to three months to monitor changes.
References
Dementia Care Central. (2022). Mini-Mental State Exam (MMSE) Alzheimer’s / dementia test: Administration, accuracy and scoring.
Hsieh, C. J., Yin, P. F., Chiu, C. Y., Hsiao, Y. P., & Hsiao, Y. L. (2022). Support and empowerment for older adult spousal caregiving of people with mild and moderate dementia: A participatory action research. Healthcare, 10(3), 569.
Kudlicka, A., Martyr, A., Bahar-Fuchs, A., Sabates, J., Woods, B., & Clare, L. (2019). Cognitive rehabilitation for people with mild to moderate dementia. Cochrane Database of Systematic Reviews, (8), CD013388.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) Elsevier.