Analysis of Alzheimers Disease Case - Essay Example

 Decision one involved starting the patient on Exelon (rivastigmine) 1.5mg PO BID with an increase to 3mg BID in two. The second decision is involved beginning the patient on Aricept (donepezil) 5mg PO at bedtime. Thirdly, the patient was to be started on Razadyne (galantamine) 4mg PO BID.

First of all, the decision to administer rivastigmine 1.5mg as a start dose is supported by evidence from the literature. For example, a study done by Ray et al. (2020) showed that rivastigmine is used for symptomatic treatment of mild to moderate symptoms of Alzheimer’s Disease. The case patient showed most of the symptoms, including memory loss, difficulty in walking and balance, and confusion. In this case, rivastigmine suppresses the mentioned symptoms through the inhibition of butyrylcholinesterase and acetylcholinesterase. The second decision, which involved administering donepezil, is also evidenced by literature to be effective in the treatment of dementia due to Alzheimer’s Disease. According to Birks & Harvey (2018), donepezil, a cholinesterase inhibitor, treats symptoms of Alzheimer’s Disease by reversely binding to acetylcholinesterase to inhibit the hydrolysis of acetylcholine. Thirdly, galantamine, a tertiary alkaloid, is used to treat vascular dementia in Alzheimer’s Disease by enhancing cholinergic function. Davis (2016) claims that cholinesterase inhibitors, such as galantamine, are the major drugs used to treat symptoms of Alzheimer’s Disease.

The decisions made regarding the treatment of Alzheimer’s Disease were aimed to treat the symptoms of dementia, such as memory loss, lack of concentration, difficulty in performing daily tasks, confusion, and mood changes. The three selected medications, i.e., rivastigmine, donepezil, and galantamine function by enhancing cholinergic function. The cholinergic function then enables the cholinergic system to perform normal cognitive functions, including memory, emotional processing, and selective attention (Hampel, 2018). However, the drugs selected in the three decisions did not bring the desired outcomes.

Indecision one, the goal was to ensure that the case-patient records a change in some of the symptoms such as the development of a positive mood and the ability to carry out usual activities. Instead, he showed no positive improvement, as reported by his son. In this case, the time given for the prescribed medication was less than one month, and this could not give the supposed outcomes. Also, the initial dosage of rivastigmine 1.5mg might have been low enough to bring the desired effect due to the severity of the patient’s symptoms.

After adjusting the dosage for rivastigmine to 4.5mg, the patient experienced partial improvement such that he could take part in some activities such as attending religious services with the family. In this regard, the increased dosage was enough to bring the desired effect to the patient, which could not be attained by a lower dose. Giving the patient more time could give better results. The positive outcomes attained after increasing the dose mean that the patient’s symptoms needed an adjusted dose. As such, dosage adjustment needs to be done in the other decisions to bring an effect. Furthermore, adding memantine to the prescription could improve the outcomes after four weeks.