Case Study For Neurologic Disorders Discussion

Neurologic Disorders

The patient in this case study is a man named Mr. Akkad, who is 76 years old and was presented to the clinic by his son because he had been behaving in a strange manner. According to the results of his Mini-Mental State Exam, he has mild dementia. Specifically, he has difficulties with orientation, recollection, concentration, and calculating. He was given a diagnosis of Major neurocognitive disorder due to Alzheimer’s disease. Case Study For Neurologic Disorders Discussion

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My first decision for Mr. Akkad was to have him take 1.5 milligrams of Exelon twice a day orally, with the goal of increasing his dosage to 3 milligrams in two weeks. After a period of four weeks, he underwent re-evaluation. At the subsequent appointment, the client’s symptoms were unchanged. The MMSE was performed on the individual, and there was no change in his score. The second decision was to raise the dosage of Exelon to 4.5 milligrams to be taken orally twice daily, with a further check-in scheduled for four weeks thereafter. At the subsequent appointment, the patient’s son reported that his father had been doing well with the medicine. On the other hand, the symptoms did not show any signs of improvement. A positive indicator of the client’s condition was that he had begun to attend religious services with his family. Because the client had a good response to the drug and had made some headway, it was prudent to keep the dosage the same and schedule a follow-up appointment for four weeks later. It was essential to ensure that the son fully understood that although the drug might temporarily alleviate symptoms, it would not address the underlying condition that was causing them.

In my opinion, the decisions that were taken were backed by evidence-based literature. According to the findings of several studies, there is currently no treatment that can reverse the effects of Alzheimer’s disease (Huang et al., 2020)Case Study For Neurologic Disorders Discussion. Nonetheless, the optimal therapy for the symptoms may be developed with the support of the evidence-based practice. Cholinesterase inhibitors are currently the most effective medicine for treating mild to moderate cases of Alzheimer’s disease. Razadyne, Exelon, and Aricept are cholinesterase inhibitors that have been proven effective for Alzheimer’s disease symptoms like loss of memory and difficulty concentrating for extended periods of time (Sharma, 2019). They achieve their beneficial effects by inhibiting the synthesis of acetylcholine found in the brain.

I was expecting that by making the decisions that were indicated above, I would be able to delay the progression of the symptoms and alleviate certain behavioral indicators, which would then allow the client to function normally. The client was given a prescription for Exelon, which is a cholinesterase inhibitor (Atri, 2019). His son indicated during the first follow-up appointment that the medicine was not doing anything to assist. Fortunately, following a dosage increase, the client started attending religious activities with his family by the time of the second follow-up. My expectations were that the client would keep his mental abilities while seeing a reduction in the severity of his symptoms and an improvement in certain behavioral patterns. Since the client is now able to join in on religious activities with his family members, it is clear that the drug is having a positive effect. It may take many months of treatment with this medication before the symptoms are able to reach a stable state. It is essential to have a conversation about this matter with Mr. Akkad’s family.

References

Atri, A. (2019). Current and future treatments in Alzheimer’s disease. Seminars in Neurology, 39(02), 227-240. https://doi.org/10.1055/s-0039-1678581

Huang, L., Chao, S., & Hu, C. (2020). Clinical trials of new drugs for Alzheimer disease. Journal of Biomedical Science, 27(1). https://doi.org/10.1186/s12929-019-0609-7

Sharma, K. (2019). Cholinesterase inhibitors as Alzheimer’s therapeutics (Review). Molecular Medicine Reports. https://doi.org/10.3892/mmr.2019.10374 Case Study For Neurologic Disorders Discussion

Neurologic Disorders and Opioids: Alzheimer’s Disease

The case study presents a 76-year-old Iranian male patient who presumably has been diagnosed with Alzheimer’s. The claim is grounded on his eldest son’s assertions and information on the disease history. No other organic ailments or processes were detected during the clinical tests and other examinations.  Two years ago, behavioral problems began, including personality changes, difficulty finding the perfect words during the discussion, memory loss, and extensive apathy. Confabulation is also observed during the physical examination, diagnostic interview, and conversation and when the patient reports being in a dysphoric state. Additionally, the patient exhibits impaired insight, judgment, and poorly coordinated impulse control. There is no incidence of suicidal ideations. Ultimately, Alzheimer’s disease-related neurocognitive impairment is clinically determined as Mr. Akkad’s precise diagnosis.

Various therapeutic decisions would be formulated to alleviate and possibly treat Mr. Akkad’s underlying health pathology. The initial approach entails recommending Mr. Akkad take Donepezil 5mg, notably a few hours before retiring to time. Over the years, Donepezil has been researched in patients with Alzheimer’s disease to evaluate its effectiveness. Being an acetylcholinesterase inhibitor, Donepezil plays an integral role in compensating for cholinergic neurons’ decreased functionality and bolstering the brain’s acetylcholine levels (American Academy of Family Physicians, 2019)Case Study For Neurologic Disorders Discussion. Moreover, a meta-analysis of clinical studies examined the effect of Donepezil on individuals with Alzheimer’s disease.

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The findings indicate that Donepezil is helpful in three important treatment areas for this illness, including functional capacity, behavioral modification, and cognition (Breijyeh & Karaman, 2020). These are the primary aspects of the patient’s condition that would be significantly impacted. The objective would be to minimize their influence on his life’s quality and enhance independence in the performance of activities of daily living. As evidenced in the case, significant personality changes negatively affected his participation in interested and pleasurable activities. However, it is necessary to highlight Breijyeh and Karaman’s (2020) assertion that limited data compares the most effective pharmacological agents in approaching Alzheimer’s disease, notably regarding the first-line therapeutic approaches.

The results of donepezil usage are variable due to the possibility of developing undesirable side effects and limited therapeutic advantages. The patient would complain of common adverse effects, including anorexia, vomiting, weight loss, and donepezil-induced diarrhea. The second option would entail incorporating cognitive behavioral therapy into the patient’s treatment regimen (Linn et al., 2020)Case Study For Neurologic Disorders Discussion. In various clinical trials, this psychological treatment approach is beneficial for patients with Alzheimer’s disease, notably in its initial stages.

Evidence capitalizing on psychosocial therapies for Alzheimer’s patients has been identified in a few isolated instances. However, actual evidence for these techniques is currently few. According to some researchers, behavioral therapies are acceptable for individuals with neuropsychiatric disorders. As a result, they are prescribed to patients to enhance their behavior, increasing their self-control and alleviating apathy (Rosenthal & Burchum, 2021). The improved mood benefits the patient’s quality of life and capacity to engage in cognitively beneficial engagements.

Thirdly, the inclusion of family members into the treatment process would be proposed to reaffirm and maintain beneficial habits. According to the American Academy of Family Physicians (2019), older adults have a high rate of non-adherence to health care interventions. This impairs the capacity to evaluate the efficacy of therapies, as poor prognosis may be attributable to ineffective medication usage. The objective is to strengthen Mr. Akkad’s support system and daily physical and social engagements. Rosenthal and Burchum (2021) posit that this approach has improved emotional and cognitive well-being among dementia patients. The results in the exercise significantly match the expected outcomes per the proposed decisions. These decisions would optimally enhance the patient’s health outcomes and alleviate the disease’s impact on their quality of life. Case Study For Neurologic Disorders Discussion

References

American Academy of Family Physicians. (2019). Dementia. Retrieved from http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=5

Breijyeh, Z., & Karaman, R. (2020). A comprehensive review on Alzheimer’s disease: Causes and treatment. Molecules, 25(24), 5789.

Linn, B. S., Mahvan, T., Smith, B. E. Y., Oung, A. B., Aschenbrenner, H., & Berg, J. M. (2020). Tips and tools for safe opioid prescribing. The Journal of family practice, 69(6), 280-292.

Rosenthal, L., & Burchum, J. (2021). Lehne’s Pharmacotherapeutics for Advanced Practice Nurses and Physician Assistants-E-Book (2^nd Edition) Elsevier Health Sciences. Case Study For Neurologic Disorders Discussion

BACKGROUND Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal. According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.” Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation. SUBJECTIVE During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Case Study For Neurologic Disorders Discussion Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia. MENTAL STATUS EXAM Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When you asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation. Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive) Decision Point One Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks RESULTS OF DECISION POINT ONE Client returns to clinic in four weeks The client is accompanied by his son who reports that his father is “no better” from this medication. He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors You continue to note confabulation and decide to administer the MMSE again. Mr. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall Decision Point Two Increase Exelon to 4.5 mg orally BID RESULTS OF DECISION POINT TWO Client returns to clinic in four weeks Client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better He states that his father is attending religious services with the family, which the son and the rest of the family is happy about. He reports that his father is still easily amused by things he once found serious Decision Point Three Increase Exelon to 6 mg orally BID Guidance to Student At this point, the client is reporting no side effects and is participating in an important part of family life (religious services). This could speak to the fact that the medication may have improved some symptoms. you needs to counsel the client’s son on the trajectory of presumptive Alzheimer’s disease in that it is irreversible, and while cholinesterase inhibitors can stabilize symptoms, this process can take months. Also, these medications are incapable of reversing the degenerative process. Some improvements in problematic behaviors (such as disinhibition) may be seen, but not in all clients. At this point, you could maintain the current dose until the next visit in 4 weeks, or you could increase it to 6 mg orally BID and see how the client is doing in 4 more weeks. Augmentation with Namenda is another possibility, but you should maximize the dose of the cholinesterase inhibitor before adding augmenting agents. However, some experts argue that combination therapy should be used from the onset of treatment. Finally, it is important to note that changes in the MMSE should be evaluated over the course of months, not weeks. The absence of change in the MMSE after 4 weeks of treatment should not be a source of concern. Review the interactive media piece assigned by your Instructor. Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece. Case Study For Neurologic Disorders Discussion

Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned. You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment. By Day 7 of Week 8 Write a 1- to 2-page summary paper that addresses the following: Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources. What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources. Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.