Paper Example on Understanding Dementia: Causes, Symptoms and Treatments

Introduction

Dementia refers to a group of symptoms that affects an individual's memory as well as the social abilities that is enough to interfere with their daily life. Research has shown that dementia is not a specific disease. However, several different mental conditions have been shown to have a significant contribution to dementia. Alzheimer's disease is the most common cause of progressive dementia and causes about 60-70 percent of the cases (Briggs, Kennelly, & O'Neill, 2016). The reports by the WHO showed that nearly 5 million people in the United States have Alzheimer's Dementia disease. Another 35 million people suffer outside the U.S. The research has further demonstrated there is a considerable rise in the cases of dementia in the U.S, with new cases of this disease developing after every 66 seconds, However, it is projected that with the current healthcare system, there will be a high prevalence, with new cases expected to develop after every 33 seconds. While Alzheimer's disease is the most common form of dementia, other forms of dementia exist and include vascular dementia, dementia with Lewy bodies, and the group of dementia that contribute to frontotemporal dementia (Briggs, Kennelly, & O'Neill, 2016). There is currently no treatment for dementia or to alter its progressive nature. This is based on the fact that many treatment options are still subjected to investigation in various clinical trial stages (Dingfelder, 2009). This paper therefore offers a discussion of the pharmacological decisions methodologies involved in the dementia patients' treatment.

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Exelon (Rivastigmine)

The Exelon (rivastigmine) is one of the approved treatments for mild to moderate dementia that is caused by both Alzheimer's and Parkinson's diseases. The treatment functions to improve the nerve cells in the brain and belong to a group of drugs known as the Cholinesterase inhibitors. To effectively work, the nerve cells communicate with one another and with the muscles cells through the use of the signaling molecules known as the neurotransmitters. This is based on the fact that the molecules are released from the nerve cells, thereby stimulating response upon the arrival. The recommended dosage for this treatment involves 6-12 mg per day, which is taken twice a day. According to Atri (2019), Exelon has a critical role in relation to binding to protein at 40 per cent, where it is subjected to a rapid process of metabolism with the major channel of elimination been the renal route.

Aricept (Donepezil)

This is another medication that treats the symptoms of dementia caused by Alzheimer's disease. The Aricept form an integral component of the category of drugs known as the Cholinesterase inhibitors. The enzyme involved in the reverse process in this case is known and the acetylcholinesterase. The acetylcholinesterase breaks down the neurotransmitter that is called the acetylcholine to enhance the concentration of the drug in the brain. Research has linked Aricept with several side effects that include vomiting, weight loss, diarrhoea, fatigue and depression. The drug is available both in form of tablet or oral suspensions that are commonly prescribed at 5mg a day. In the cases where the tolerance is appropriate, Aricept is available in tablet form and is commonly started at 5 mg a day. In case it is well tolerated after 4-6 weeks, the dosage may be changed depending on the prescription of the doctor.

Razadyne (Galantamine)

Razadyne ER is a cholinesterase inhibitor that operates through the restoration of the balance of certain natural substances in the brain used to treat mild to moderate dementia caused by Alzheimer's disease (Atri, 2019). This drug is available in its generic form. Various side effects have been largely associated with Razadyne. These include vomiting, appetite loss, nausea, weight loss, fatigue and headache among others. The starting dosage should be taken as per the prescription of the physician. A required dosage is usually 8mg per day but this amount can be increased depending on doctor's prescription.

Decision Point 1

As part of the decision point one, the client was to be subjected to any of the three discussed drugs namely the Exelon, Aricept or Galantamine. The chosen option was to begin with the Aricept taken through oral administration at the bedtime. Its long half-life of nearly 70 hours. The decision to leave the other two medication is based on the fact that they only treat the mid to moderate Alzheimer's stages. This makes the Aricept the most appropriate option in this case. The anticipated results of this medication is to gain a considerable symptom reduction.

Decision Part 2

The choice for decision point two was aimed at increasing the current medication of Aricept dosage to 10 mg or cease the present medication and switch to Galantamine over an extended period of time on a daily basis. The decision to increase Aricept to 10 mg orally at bedtime constituted a great opportunity to increase Aricept to 10 mg because Aricept 5 mg was not therapeutic for the patient. The drug still proves to be the best and more due to the limited reports regarding hepatotoxicity or drug interaction.

Decision Part 3

Possible decisions to select from include to continue Aricept 10 mg orally at bedtime, or Increase Aricept to 15 mg orally bedtime x6 weeks, then increase to 20 mg orally at night, or Discontinue Aricept and begin Namenda 5 mg orally daily. This would mean that the continue Aricept 10 mg orally at bedtime. I selected to maintain current medications because the client is tolerating the medication and we have seen some slight improvement in symptoms by client attending religious services and no reported side effect. I decided not to select the other decisions because the client's symptoms have improved with no reported side effect, there is, therefore, no need to change medication.

Ethical Considerations

The treatment of patients with dementia requires consideration of various ethical issues. Notably, the psychiatric mental health nurse practitioners (PMHNP) must demonstrate a high level of awareness of the challenges that older people undergo, the vulnerability, their feelings of loneliness, their cognitive capacity, and financial status. Nurses must further be able to practice morality when dealing with patients. Morally, they must show competence in ter knowledge and skills when it comes to the understanding of the process of aging in older people. Any treatment that the patients are subjected to must further be ethically accepted.

Conclusion

In conclusion, there is a massive rise in the cases of dementia in the U.S with new cases of this disease developing after every minute. Various treatment options are available for the clients suffering from the dementia. These are approved medication which have been proven to treat all stages of Alzheimer's disease. Other than the treatments, ethical issues must also be taken into consideration when involving patients. The treatment of patients with dementia requires the attention of various ethical issues. Notably, the psychiatric mental health nurse practitioners (PMHNP) must demonstrate a high level of awareness of the challenges that older people undergo, the vulnerability, their feelings of loneliness, their cognitive capacity, and financial status. This will help develop a good understanding with older people.

References

Atri, A. (2019, April). Current and Future Treatments in Alzheimer's Disease. In Seminars in neurology (Vol. 39, No. 02, pp. 227-240). Thieme Medical Publishers.

Angermeyer, M. C., Matschinger, H., & Schomerus, G. (2013). Attitudes towards psychiatric treatment and people with mental illness: Changes over two decades. The British Journal of Psychiatry, 203(2), 146-151. Retrieved from http://bjp.rcpsych.org/content/203/2/146.full

Briggs, R., Kennelly, S. P., & O'Neill, D. (2016). Drug treatments in Alzheimer's disease. Clinical medicine, 16(3), 247-253.

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20-22. Retrieved from http://www.aafp.org/journals/afp.html

Dingfelder, S. F. (2009). Stigma: Alive and well. American Psychological Association, 40(6), 56. Retrieved from http://www.apa.org/monitor/2009/06/stigma.aspx

Jenkins, J. H. (2012). The anthropology of psychopharmacology: Commentary on contributions to the analysis of pharmaceutical self and imaginary. Culture, Medicine and Psychiatry, 36(1), 78-79. Doi: 10.1007/s11013-012-9248-0

Jeppsson, F. (2016). Characterization of Diagnostic Tools and Potential Treatments for Alzheimer's disease: PET ligands and BACE1 inhibitors (Doctoral dissertation, Department of Neurochemistry, Stockholm University).