Psychotic & Cognitive Disorders

Summary of Clinical Case

TM, a 79-year-old man, had dementia identified six years before. Subjectively, her wife explains how his condition gradually deteriorated to the point where, in recent months, she has finding it more challenging to manage him. He also has grown more foul and aggressive. Besides, he has started griping about seeing individuals lurking around the house, which makes him feel uneasy. He has fled the house twice, and both times he was discovered lost on the street. TM’s condition also fluctuates as he is sometimes confused and aggressive, while during other moments he is lucid and calm.

DSM-5-TR Diagnosis

Based on DSM-5-TR criteria, TM experiences symptoms of Dementia. According to the criteria, individuals with dementia should exhibit significant cognitive decline more that one of the cognitive domains based on significant impairment of cognitive abilities, poor judgment, difficulty in speaking, confusion, getting lost and wandering, challenges in paying bills, delusion, hallucinations and paranoia, impulsive behavior, losing balance and repetitive behavior (Tay & Subramaniam, 2023). TM experiences most of these symptoms. First, he experiences cognitive decline which has led to deterioration of his condition. He is also confused and wanders around the neighborhood. He also experiences paranoia since he complains that he sees people wandering in his house. Besides, he is aggressive and hostile.

Pharmacological Treatment

An effective pharmacological treatment I would prescribe for the TM is donepezil. It is appropriate for treating symptoms of dementia such as disease symptoms like disorientation and memory loss. This medicine works by enhancing your focus, memory, and capacity to carry out daily tasks. It does not treat dementia or Alzheimer’s disease (Kurian et al., 2021). TM must adhere to the instructions listed on the prescription label. Along with or without food, and at scheduled times, he can consume this drug. It is customary to take this medication right before bed. Even if TM feels better, he will keep taking this drug. I would advise him to consume the 23 mg donepezil tablet whole and not to cut, smash, or chew it.

Non-pharmacological Treatment

For non-pharmacological treatment I will recommend for TM is lifestyle changes. First, he should engage in physical activity. Strength, balance, and cardiovascular health are all enhanced by exercise in dementia patients. With symptoms like agitation, exercise might also be beneficial (Castillo-García et al., 2022). I will help him plan enjoyable and doable activities such as connecting with his loved ones, and helping him focus on what he can still accomplish. At night, cognitive abilities tends to deteriorate. I will help TM create bedtime routines that are relaxing and distant from the noise and occupied family members. Caffeine restrictions, prohibitions against naps, and opportunities for daytime activity will all help him reduce evening restlessness.

Assessment of Treatment

Appropriateness

The most popular application for the acetylcholinesterase inhibitor donepezil hydrochloride is the management of dementia. The FDA has given donepezil approval to treat dementia in severe, moderate, and mild forms (Kurian et al., 2021). The medicine helps in  enhancing reasoning or behavior, and reduces some indicators. Additionally, it has additional off-label uses. TM can start with a dose of 5 mg/day. This can be increased to 10 mg/day after six weeks.

Cost

The price for a supply of 30 donepezil oral tablet 10 mg costs about $14., as per walmart.com.

Effectiveness

The main symptoms of dementia illness are improved with donepezil, which can be tolerated easily and is more successful than a placebo. The majority of the time, improvements are small, although stabilizing cognitive and behavioral issues with donepezil may also be seen as a significant clinical result (Castillo-García et al., 2022). The stress on caregivers might decrease with donepezil.

Safety

The safety and tolerability of donepezil have been established. Drowsiness digestive problems (such as nausea, lack of appetite, bloating, loose stool, and dysentery), insomnia, and exhaustion are among the donepezil adverse effects that are frequently reported (Tay & Subramaniam, 2023).

Potential for Adherence

75% of patients who take donepezil as prescribed could get a reaction. This is due to the numerous negative effects it has.

References

Castillo-García, I. M., López-Álvarez, J., Osorio, R., Olazarán, J., Ramos García, M. I., & Agüera-Ortiz, L. (2022). Clinical trajectories of neuropsychiatric symptoms in mild-moderate to advanced dementia. Journal of Alzheimer’s Disease, (Preprint), 1-15. DOI: 10.3233/JAD-215133

Kurian, T. A., Balachandran, S., & Francis, Y. K. (2021). A Cross-Sectional Study on the Frequency of Behavioural and Psychological Symptoms of Dementia in Alzheimer’s Disease in a Tertiary Care Hospital of North Kerala. Based Med Healthc, 8(24), 2006-2010. DOI: 10.18410/jebmh/2021/377

Tay, K. W., & Subramaniam, P. (2023). Dementia: Features of treating anxiety and depression and the role of cognitive behavioral therapy: A new narrative. In Handbook of Lifespan Cognitive Behavioral Therapy (pp. 337-344). Academic Press. https://doi.org/10.1016/B978-0-323-85757-4.00040-7