Major Neurocognitive Disorder due to Alzheimer's Disease

Alzheimer's Disease
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Alzheimer's Disease
Mr. Akkad, a 76 years old Iranian man, is presented with strange behavior and strange thought. His son reports that he has lost interest in religious activities in the past two years, was increasingly ridiculing things he would have otherwise taken seriously, struggles to find words in a conversation, and sudden shifts or changes in conversation line. The son further reports that the father has forgotten things lately, an accumulation of what he describes as 'strange behavior and thought.' Mr. Akkad scored 18 out of the 30 on the Mini-Mental State Exam (MMSE), indicating that he has moderate dementia. Further mental status examination reveals partial disorientation to place and full disorientation to event and time. His insights and judgments also appear to be impaired. Therefore, the patient was diagnosed with Major Neurocognitive Disorder due to Alzheimer's disease.
The first decision point involved subjecting the client to Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg Bid after two weeks. After four weeks, the client returns with his son reporting the father's condition has not improved. In the MMSE test, he scores 18 out of the 30 with primary deficits in core areas. The next decision is to increase Exelon to 4.5 mg orally BID. After four weeks, Mr. Akkad tolerated the medication, but his condition was the same as before. The decision is to maintain the current dose until the next visit (after 4 weeks).
All three decisions are supported by evidence-based literature. For instance, in the first decision, rivastigmine, the base component of Begin Exelon, has been found to have significant benefits for people who have Alzheimer's disease (AD). In their study, Birks, Chong, and Evans (2015) investigated rivastigmine's clinical efficacy and safety for patients with Alzheimer's disease. Outcomes showed that 6 to 12 mg daily orally is beneficial for these patients. Similarly, Li et al. (...