1
Alzheimer Client
Decision Tree Week 10
Name
2022
Alzheimer’s Client
Case Study: An Elderly Iranian Man With Alzheimer’s
Alzheimer's disease is the "most common form of dementia," with almost 5 million
people predicted to rise by 2014 to over 14 million by 2060. But, what is Alzheimer's condition?
According to the Alzheimer's Association (2018), this is a disease not part of a normal aging
process, where gradual memory loss happens over time (Alzheimer's Association, 2018).
Decision One
According to Mayo Clinic (2018), there are 3 medications for the treatment of
Alzheimer's symptoms. Cholinesterase inhibitors are classified as medications for the treatment
of symptoms such as Aricept, Exelon, Razadyne. Through the development of Alzheimer's
disease, acetylcholine is a neurotransmitter that reduces memories, emotions and judgements
(Mayo Clinic, 2018). The inhibitors of cholinesterases contribute to increased brain acetylcholine
production by blocking the acetylcholinesterase enzyme (AChE) (Stahl, 2013). This condition
diagnosed Iranian client with mild dementia that could be associated with the disorder of
Alzheimer's. In light of the customer's symptoms of lack of memory, change of temperament,
outlook and judgment, Aricept was determined to start 5 mg at bedtime on a daily basis. The
decision was made because a dose of 5 mg once daily at bedtime was correctly prescribed to help
keep the drug in line (Stahl, 2014b).
Goals and Results
The goal is to reduce memory losses (Stahl, 2014b). Use of any CI is not normal to
reverse the symptoms of Alzheimer's disease and time is needed to see the full effectiveness of
the medication (Stahl, 2014b). Long-term care can be put and routine tasks can be minimized
while the burden on caregivers can be decreased (Stahl, 2014b). Unfortunately, with the first
decision on the initial Aricept dose, these goals were not met. This is also anticipated as most
customers are able to reduce side effects at a slower titration after an initial dose of six weeks
(Stahl 2014b).
Decision Two
Due to the limited response to Aricept therapy, gradual start-up and titration are required
to reduce side effects. Stahl (2014b) also notes that the customer can need the most acceptable
dose within the usual range. The dosage was raised by 10 mg at bedtime, since Aricept's normal
range of dosage is 10 mg orally per day (Stahl, 2014b).
Goals and Outcomes
The treatment plan only delays the course, but the drug is well tolerated with moderate
titration without side effects (Stahl, 2014b).
Decision Three
Since the client responded to dosage increase, the third decision was to continue
administering Aricept. A dosage of 10 mg was not effective but the dosage would increase the
risk of serious adverse effects, such as heart failure (Stahl 2014b).
Goals and Outcomes
As stahl (2014b) indicated, there were no adverse reactions to Aricept treatment plan. In
addition, stopping Aricept can lead to a memory loss that cannot be restored, as shown by Stahl
(2014b).
Ethical Implications
The lack of judgement and perspective is one of the most critical ethical considerations
when working with such a client. This makes it almost difficult to have informed consent. As
stahl (2014b) says, the provider must handle the patient but monitor the efficacy of the treatment
plan with the caregivers.
References
Alzheimer’s Association (2018). What is Alzheimer’s? Retrieved from
https://www.alz.org/alzheimers-dementia/what-is-alzheimers
Mayo Clinic (2018). Alzheimer’s: Drugs help manage symptoms. Retrieved from
https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/in-depth/
alzheimers/art-20048103
Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical
applications (4th ed.). New York, NY: Cambridge University Press.
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University
Press.
