Post- Esther

5

Alzheimer’s Disease

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Alzheimer’s Disease

Diagnostic criteria

The diagnosis of Alzheimer’s disease highly depends on the level of documentation of a patient's mental decline. Biomarkers have been recently added to the diagnostic criteria because they can be accurately measured to indicate the presence of Alzheimer’s disease. Examples include tau and beta-amyloid ratios in the cerebrospinal fluid and structural changes in the brain that can be detected by neuroimaging. Biomarker proportions change at various disease stages, making them suitable for diagnosing the level of brain damage caused.

The intensifying use of neuroimaging and analysis of cerebrospinal biomarkers help the PMHNP to achieve higher diagnostic accuracy. The latest criteria can help PMHNP recognize the onset of non-amnestic or amnestic symptoms across several cognitive domains (Alzheimer's Association, 2018). The presence of cerebrovascular illness is currently considered a high-risk condition for AD. However, the presence of substantial cerebrovascular infections decreases the certainty of AD diagnosis. Other comorbidities include depression, thyroid problems, Lyme disease, vitamin deficiencies, sleep apnea, and delirium. Unlike AD, these comorbidities are reversible via appropriate treatment. Additionally, Age-linked cognitive transitions are confused with AD. Thus, additional imaging tests and identification of biomarkers can help differentiate AD from normal aging factors and comorbidities.

Evidence-based management practices

One of the evidence-based psychotherapy treatment that is used for patients with Alzheimer’s disease is reminiscence therapy. The therapy involves the use of all the patient’s senses, touch, sight, smell, taste, and sound, to help the individuals with Alzheimer’s dementia remember events, places, and people from their past lives (Woods et al., 2018). Cognitive-behavioral therapy is also used to change the behaviors of a patient with Alzheimer’s Disease.

There are two types of psychopharmacologic treatments that are prescribed to patients with Alzheimer’s disease. The first drug is cholinesterase inhibitors. The drug is prescribed to patients with mild to moderate Alzheimer’s disease. The second drug is Namenda (memantine). The drug is prescribed to reduce the symptoms of Alzheimer’s disease to maintain the patient’s normal daily functions (Folch et al., 2016).

Continuous mind engagement, such as reading books and stories, could help control AD symptoms' severity. While no studies have demonstrated a connotation between AD risk and educational level, James and Patwik (2018) reported that continuous engagement of the mind improves memory. Body exercise improves brain plasticity, remodel neuronal circuitry, stimulates neurogenesis, and promotes brain vascularization. Cognitive interventions are alternative and complement pharmacological interventions. These are categorized into cognitive rehabilitation (CR), cognitive stimulation (CS), and cognitive training (CT). CT improves attention, memory, language, and executive functions (Middleton, 2020). CR involves setting goals to improve participation in daily activities. CS involves all activities that arouse various cognitive domains and may include body exercise, diet, and reading. However, AD symptoms that inhibit psychological functions and behaviors can affect patient health and safety; therefore, additional pharmacological treatment is designed to improve patient outcomes.

Evidence-based pharmacological treatment includes antidepressants to reduce agitation symptoms, antipsychotics to reduce psychosis and aggression, and mood stabilizers to improve patient mood. Examples of documented antidepressants include trazodone, sertraline, and citalopram. Effective and validated antipsychotics include risperidone and olanzapine. Carbamazepine and placebo are among the mood stabilizers that have produced statistically significant mood improvement.

Possible risks and how treatment can be transformed

Some various benefits and risks are associated with therapy. However, the benefits outweigh the risks. The benefit of psychotherapy is that it has a higher chance of success. Thus, most of the patients are helped to improve by therapy. It is also easier and it does not entail using a lot of energy as it works with minimal prompting. It also helps to evoke positive feelings in patients. The risks that are involved include the development of bad feelings for the therapist, it consumes a lot of time, and it may result in complicated feelings in a patient.

Various pharmacological treatments can trigger some side effects that may worsen the disease conditions and increase a patient and family's additional burden. The benefits of a certain medication should be weighed against the documented side effects. Starting a pharmacological treatment with a higher dose can cause the patient to become intolerant because of their side effects. Thus, any clinician treating an AD patient should begin with a minimum dose and then augment it after an effective trial. Any medication that causes unpreceded side effects that endanger a patient’s health and life must be discontinued. Clinicians must also be cautious for any combination of pharmacological agents in the same medical category because they can increase morbidity or cause unpredicted death. Even after successful trials, the continuing medication should be re-evaluated regularly, especially among the geriatric population where polypharmacy is common. Antipsychotics have adverse long-term effects and must be prescribed for short-term use and at close monitoring. Family members must be involved in the treatment to assist a patient in making prudent decisions.

References

Alzheimer's Association. (, 2018). 2018 Alzheimer's disease facts and figures. Alzheimer's & Dementia, 14(3), 367-429.

Folch, J., Petrov, D., Ettcheto, M., Abad, S., Sánchez-López, E., García, M. L., ... & Camins, A. (2016). Current research therapeutic strategies for Alzheimer’s disease treatment. Neural Plasticity, 2016.

Middleton, L. E. (2020). Altering Dementia Risk: Can Fitness Overcome Obesity in Relation to Cognition?. Canadian Journal of Cardiology, 36(11), 1703-1705.

Woods, B., O'Philbin, L., Farrell, E. M., Spector, A. E., & Orrell, M. (2018). Reminiscence therapy for dementia. Cochrane database of systematic reviews, (3).