Noledweed-Guethy Jean-Baptiste
Jul 23 8:32am
Reply from Noledweed-Guethy Jean-Baptiste
Prescribing for Older Adults and Pregnant Women
Dementia and Alzheimer’s disease are common causes of cognitive decline in older adults. According to the DSM-5, between sixty and eighty percent of dementia cases are caused by neurocognitive decline in older individuals, commonly known as Alzheimer’s disease. Dementia impairs cognitive function, making it hard to complete everyday tasks. This is not a disease but a symptom that impacts and hinders one’s ability to reason, remember, and think logically (Gerlach & Kales, 2020). Alzheimer’s disease mainly causes dementia. Multiple brain changes may manifest at the same time as the symptoms of dementia, which are a collection of symptoms that might be diverse. Memory loss and other critical cognitive abilities are impacted by Alzheimer’s disease, a degenerative disorder (Kriebel-Gasparro, 2020). Because it mainly causes dementia, this disease deteriorates and kills brain cells by breaking their connections with one another. The deterioration of memory and other fundamental mental abilities directly results from this process. Memory loss and disorientation are symptoms of Alzheimer’s disease, which currently has no cure. Treatment and prevention efforts focus on alleviating symptoms and halting their worsening as much as possible.
The following medications have been granted approval by the FDA in United States: galantamine, memantine, donepezil, rivastigmine, and a combination of memantine and donepezil (Varadharajan et al., 2023). These drugs are designed to decelerate the advancement of Alzheimer’s disease and enhance memory and cognitive function. The efficacy of these medications is contingent upon the stage of the disease. According to the FDA, Aricept (donepezil) is seen more advantageous for individuals with mild to moderate or moderate to severe Alzheimer’s disease. According to research, the National Institute on Aging states that Aricept, galantamine , and rivastigmine have the potential to decelerate behavioral symptoms temporarily and hinder the progression of symptoms.
Mood stabilizers, antidepressants, anti-anxiety, and antipsychotic medications can change brain waves, which improves brain function. An individual’s state of mind, perceptions, and awareness can be altered by an Alzheimer’s disease medication such as Seroquel (Varadharajan et al., 2023). Although the FDA has not approved these medications, pharmacists are still permitted to dispense them as long as sufficient proof that this practice falls within reasonable standards of healthcare clinical practice and is not used for trial or experimental reasons.
Alzheimer’s disease advances gradually; therefore, it is wise to use a comprehensive approach to halt its progression. Nonpharmacological therapies for this purpose encompass validation therapy, recollection therapy, cognitive stimulation therapy, and reality reorientation as a comprehensive approach (Kriebel-Gasparro, 2020).
I will confirm a patient’s cognitive impairment by administering the eleven-question Mini-Mental Examination (MMSE). In order to make an informed decision, this evaluation is vital (Folstein et al., 2020). Genetic assessment risk variables obtained from a comprehensive family history is another evaluation methodologies that could be used. According to a number of scientific guidelines, simple lifestyle changes can help avoid illness, delay its progression, or better manage its negative side effects. These lifestyle adjustments encompass consistent engagement in physical and mental exercise, modest consumption of alcohol, and the avoidance of tobacco and head injuries. There is a contradictory result in the vascular studies indicating that having a systolic blood pressure below 140 mmHg is likewise linked to a higher risk of developing Alzheimer’s disease.
Furey and Wilkins (2016) used three cholinesterase inhibitors—galantamine, donepezil, and rivastigmine—to analyze the Guidelines for Neurocognitive Disorder Therapy. The study of dementias was based on these inhibitors, which were approved by the US Food and Drugs. Both the kind of dementia determine how effectively a treatment works. The individuals who were administered Aricept (donepezil) had enhanced cognitive performance and a deceleration in the advancement of their dementias compared to those who were given placebos.
It is essential to recognize that interdisciplinary collaboration and shared clinical decision-making are vital in treating Alzheimer’s disease. It is the guiding principle for pharmaceutical companies to adhere to and distribute a medication approved by the FDA for a specific condition, even if it is being used off-label for a different purpose. It is crucial to examine the ethical and legal consequences of prescription “off-label” drugs for the patient’s well-being.
References
Folstein, M., Folstein, S., & McHugh, P. (2020). 5.2 Mini-Mental State Examination (MMSE). Manual of Screeners for Dementia, 51.
Furey, K., & Wilkins, K. (2016). Prescribing “off-label”: What should a physician disclose? AMA Journal of Ethics, 18(6), 587–593.
Gerlach, L. B., & Kales, H. C. (2020). Pharmacological management of neuropsychiatric symptoms of dementia. Current treatment options in psychiatry, 7, 489-507.
Kriebel-Gasparro, A. (2020). Update on treatments for cognitive decline in Alzheimer’s disease. The Journal for Nurse Practitioners, 16(3), 181-185.
Varadharajan, A., Davis, A. D., Ghosh, A., Jagtap, T., Xavier, A., Menon, A. J., … & Gregor, T. (2023). Guidelines for pharmacotherapy in Alzheimer’s disease–A primer on FDA-approved drugs. Journal of neurosciences in rural practice, 14(4), 566.