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Running head: ASSIG PATHOW6M5 1

ASSIG PATHOW6M5 5

Assig PathoW6M5

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Advanced nurse practitioners are frequently the first healthcare providers dealing with patients with problems with their cognition and behaviors. While individuals age, they suffer from mild cognitive decline, but these do not highly influence their relationships and usual functioning. However, when behaviors change from normal, screening is necessary to assess and diagnose. Routine examinations will help healthcare providers to design pharmaceutical interventions (Schroeder, Martin & Walling, 2019).

Case study

Mr. Akkad, 76 years old, a Middle Easterner male, is accompanied by his son, who reported strange behavior from his father. The son relates his father's history and can provide a reliable narrative. He says that his father's symptoms started a few years ago when he lost interest in his family, changed his personality, and could not find words during a conversation, so he changed topics. These symptoms worsened in two years, and the personality changes were worrisome. The son stressed that the slowly dwindling memory and growing hostility towards people around him made it hard for them to help him with his daily functioning.

Decision tree

The first decision is to initiate a treatment therapy for the patient based on his behavior where he would go somewhere he did not know about repeatedly, as well as the result of the mini-mental status exam (MMSE) score (18/30), which shows that he has moderate dementia (Schroeder, Martin & Walling, 2019). For this, it is recommended that Mr. Akkad takes Aricept 5 mg orally at bedtime. He should come back for an evaluation after four to six weeks. The second decision was to increase Aricept 5 mg dose to 10 mg at bedtime since Mr. Akkad's symptoms were still evident after four weeks. However, there was no need to change the medication of Aricept because the patient had a tolerance for it.

The third decision was for Akkad to keep taking Aricept 10 mg at bedtime due to the improvement of his symptoms, and he reported no side effects of the medication (Webster et al., 2017). There is still no cure for Alzheimer's, which means that disease management aims to reduce symptoms' progression and sustain the patient's regular functions.

Evidence-based Decisions Recommending Patient Care

Deciding to prescribe Aricept was based on evidence-based research and findings of its advantages in treating mild or the onset of Alzheimer's symptoms and fewer adverse effects on patients (Epperly, Dunay & Boice, 2017). The second decision to increase the dosage of Aricept from 5 mg to 10 mg was based on the guidelines that if this dosage did not show any improvement in the patient's symptoms in 4-6 weeks, increasing it would be a viable step. Giving Mr. Akkad another medication would put him at risk of side effects. The third decision to sustain Aricept 10 mg is based on the patient's MMSE, which did not show any Worsening of cognition; thus, the present dose was effective (Rosenthal & Burchum, 2018).

Expected Response from Aricept

It is expected that Aricept would reduce the progress of Mr. Akkad's symptoms and for this MMSE to be sustained. Literature and clinical studies do not advise if Aricept controlled symptoms and there are no side effects. The patient's son was hoping for improvements in his father's symptoms for at least 12 weeks. Should pass before any Alzheimer's medication's efficacy can be observed (Webster et al., 2017).

Expectations and Results

Mr. Akkad need not see a neuropsychologist for further assessment. Namenda 5 mg can be prescribed if more cognitive deficiencies have to be addressed. Guidelines for treating the onset of Alzheimer's include exercise therapy and vitamin E 1000 IU twice daily. Studies show that behaviors and functioning are improved with the combination of pharmacological and supplemental therapies (Epperly, Dunay & Boice, 2017). Considering Exelon as the first medication produced similar advantages as Aricept. The Exelon patch could have reduced the side effects if the patient responded well in the following weeks; however, a higher dose is needed for it to be effective. The options in the decision tree regarding Razadyne 4 mg extended release daily showed the patient had to stop it since there are side effects. The medications mentioned (Aricept, Exelon, and Razadyne) are all cholinesterase inhibitors, which make neurotransmitters more available and heighten acetylcholine uptake. This, in turn, delays the progress of Alzheimer's, specifically in the hippocampus, where the memory processes (Khoury, Rajamanickam & Grossberg, 2018).

Conclusion

Treating Alzheimer's disease includes comprehending the concepts involved and helping the healthcare practitioners, specifically APNs, to make effective decisions on how and what treatment should be initiated. Moreover, it helps with comprehending the side effects that patients undergo. This will also aid in deciding whether to continue with the treatment, take alternative medications, or have supplements. The objective of Alzheimer's disease treatment is to delay or stop the progression of the disease. Alzheimer's, specifically in the hippocampus, where the memory processes (Khoury, Rajamanickam & Grossberg, 2018).

Reference

Epperly, T. D., Dunay, M. A., & Boice, J. L. (2017). Alzheimer disease: pharmacologic and nonpharmacologic therapies for cognitive and functional symptoms. American family physician, 95(12), 771-778.

Khoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current therapies for Alzheimer’s disease: focus on rivastigmine. Therapeutic advances in drug safety, 9(3), 171-178.

Schroeder, R. W., Martin, P. K., & Walling, A. (2019). Neuropsychological evaluations in adults. American family physician, 99(2), 101-108.

Webster, L., Groskreutz, D., Grinbergs-Saull, A., Howard, R., O’Brien, J. T., Mountain, G., Banerjee, S., Woods, B., Perneczky, R., Lafortune, L., Roberts, C., McCleery, J., Pickett, J., Bunn, F., Challis, D., Charlesworth, G., Featherstone, K., Fox, C., Goodman, C., . . . Livingston, G. (2017). Development of a core outcome set for disease modification trials in mild to moderate dementia: a systematic review, patient and public consultation and consensus recommendations. Health Technology Assessment, 21(26), 1–192. https://doi.org/10.3310/hta21260