Many pharmacokinetic and pharmacodynamic factors can affect the course of treatment of an elderly patient with dementia. Exposure to agents that modulate neurological function early can have long-term effects up to the senior period (Cretin, 2021). I want to highlight pharmacokinetic and pharmacodynamic factors that may increase susceptibility to these agents. With age, there is a tendency for the liver’s metabolic capacity to decrease, which may affect the ability to excrete therapeutic agents and chemicals from the environment (Pfister et al., 2017). This factor, combined with decreased renal clearance, leads to prolonged retention of many drugs in the elderly. The nervous system undergoes various changes with age, including changes in neurotransmitter and receptor levels and reduced adaptation to modifications induced by xenobiotics (Sönnerstam et al., 2018). These changes in the central nervous system can make older people more susceptible to neurological dysfunction when exposed to particular pharmacological agents.
Another critical point is the patient’s personalized treatment plan, depending on the disease or certain complications. For example, if a patient has a comorbid condition, the treatment plan would change concerning the medication prescribed. As mentioned above, it is necessary to monitor the simultaneous prescription of several medicines to an older patient, as they tend to persist and react (Reeve et al., 2017). If the patient is already taking medication for dementia, great care needs to be taken in the selection of medication, e.g., for heart failure. An overdose of drugs or unwanted interactions with each other can lead to a worsening of the patient’s overall clinical condition.
References
Cretin, B. (2021). Treatment of seizures in older patients with dementia. Drugs Aging 38(1), 181–192.
Pfister, B., Jonsson, J. & Gustafsson, M. (2017). Drug-related problems and medication reviews among old people with dementia. BMC Pharmacol Toxicol 18(1), 52.
Reeve, E., Trenaman, S. C., Rockwood, K. & Hilmer, S. N. (2017). Pharmacokinetic and pharmacodynamic alterations in older people with dementia. Expert Opinion on Drug Metabolism & Toxicology, 13(6), 651-668.
Sönnerstam, E., Sjölander, M., Lövheim, H., & Gustafsson, M. (2018). Clinically relevant drug-drug interactions among elderly people with dementia. European Journal of Clinical Pharmacology, 74(1), 1351–1360.