Summary
Mr. Akkad, a 76-year-old Iranian man is brought into the office exhibiting ‘strange behavior’ according to his son who accompanies him. The previous examination from his family physician ruled out the possibility of an organic basis. His son confirmed the presence of the symptoms for few years where Mr. Akkad lost interest in things he cherished and sometimes suffered memory loss. During the clinical interview, Mr. Akkad is cooperative and enjoys the interview. However, there is a confabulation in memory testing, which leads to a mental status exam. The patient is cooperative but has poor eye contact. His speech is coherent and clear, but sometimes tangential. His motor movements are normal, has no tic, and denies having visual or auditory hallucination. He did not have any delusional or paranoid thoughts. He seemed alert and self-oriented, partially place oriented, but the place and time disoriented. Mr. Akkad has impaired impulse control. Mr. Akkad is diagnosed with major neurocognitive disorder due to Alzheimer’s disease (presumptive).
The patient is prescribed to begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg BID in 2 weeks. During the four-week revisit, the son reports no improvement in his father’s condition. In a mini-mental exam, Mr. Akkad scores 18 out of 30 on the first visit. He had significant deficits in attention, calculation, orientation, registration, and recall. The patient is further administered to increase Exelon to 4.5 mg orally BID. The patient in the company of his son returns to the clinic after four weeks. His son reports no significant improvement in his father’s character, although he had resumed the attendance of religious services. At this juncture, the patient is provided with an increase Exelon to 6 mg orally BID. The client reports no side effects from the drug but is expected to revisit the clinic after four weeks.
Literature Review
According to Alzheimer Association, there is no cure for the disease. However, there are medications to control the progression of the symptoms. Both medical and non-medical options help to lessen the severity of the symptoms (Stafford, 2017). Nguyen et al. (2021) posited that some medications are administered to treat cognitive, and dementia-related symptoms. Other medications improve behavioral change and variation in sleep patterns. In this case, the patient was found to have significant deficits in attention, calculation, orientation, registration, and recall. He was administered with Exelon (rivastigmine) 1.5 mg with an increase to 3 mg orally BID in 2 weeks. Oral Exelon (rivastigmine) 1.5 mg is used in the treatment of Alzheimer’s Dementia and Parkinson’s Dementia symptoms.
The dosage should be increased to Exelon 4.5 mg orally BID after two weeks if the drug is well tolerated. However, the patient should discontinue if adverse effects, such as nausea, vomiting, and abdominal pains are experienced (Abhyankar et al., 2017). Since the patient shows no side effects of the disease and an increase in Exelon to 6 mg orally BID would have better results. The administration is the maximum amount of Exelon that should be given to a patient.
Expected Results
I administered Mr. Akkad with Excelon as the drug has been clinically proved to improve cognitive functioning. Cognitive performance in Alzheimer’s Disease patients has been assessed using a scale known as the ADAS-cog. The scale evaluates cognitive behaviors such as attention, orientation, memory, language, praxis, and reasoning. Mr. Akkad has exhibited deficits in most of these cognitive performances. Khoury et al. (2018) note that, although Excelon has proven to improve performance, it is usually at a rate of 6-12 units annually. This means very slow development of the improvement process. The participants of the Excelon trial recorded a decline of placebos at an average of 3-8 units yearly.
The improvement process of Mr. Akkad is as expected, as an increase in the dosage results in a higher rate of success of the drug. However, it is expected that the change process will be slow, with minimal improvement being experienced. During a clinical trial of Excelon, elderly patients scored as low as 0 and 1 rates.
References
Abhyankar, D., Shedage, A., Gole, M., & Raut, P. (2017). Bioequivalence study of rivastigmine 6 mg capsules (single dose) in healthy volunteers. American Journal of Alzheimer’s Disease & Other Dementias®, 32(6), 360-366.
Khoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current therapies for Alzheimer’s disease: Focus on rivastigmine. Therapeutic Advances In Drug Safety, 9(3), 171-178.
Nguyen, K., Hoffman, H., Chakkamparambil, B., & Grossberg, G. T. (2021). Evaluation of rivastigmine in Alzheimer’s disease. Neurodegenerative Disease Management, 11(1), 35-48.
Stafford, A. (2017). What drug? Rivastigmine. Australian Pharmacist, 36(8), 54-57.