Alzheimer’s disease is one of the most common mental disorders in older people. Although its cure completely is impossible, therapy and medications can control the disease’s development and its symptoms and partially prevent them. Mr. Akkad’s situation presented in the case study is quite common for his diagnosis; therefore, I have chosen donezipil treatment starting with 5 mg and continuing with 10 mg, since this approach is evidence-based.
Mr. Akkad is a 76-year-old Iranian male who, according to his son, has had memory problems and unusual behavior during the last two years. The examination confirmed the son’s words since Mr. Akkad scored 18 out of 30 in the Mini-Mental State Exam and has troubled coordination. Depression is the most common comorbid diagnosis; however, Mr. Akkad denies depressive and suicidal thoughts, so it can be excluded (Burke et al., 2019). For this reason, I chose Aricept (donepezil) 5mg orally at bedtime to start the treatment. A systematic review by Birks and Harvey (2018) demonstrates that donepezil positively affects memory and cognitive performance in patients with a neurocognitive disorder but has side effects. For this reason, I chose the 5 mg dosage to determine if Mr. Akkad and do not put his health at risk. Since I saw no side effects, I had increased the dose to 10 mg, which is more effective. However, the review also demonstrates that although higher doses are acceptable for treatment, they have more side effects, but at the same time, eight weeks is not enough to detect significant changes. For this reason, in the third option, I decided not to change the dosage or cancel donepezil.
I relied on the evidence from the literature to make the decision. First, systematic reviews from Birks and Harvey (2018) and Adlimoghaddam et al. (2018) came to approximately the same conclusions about the benefits of donezipil and its side effects depending on the dosage. At the same time, according to the pyramid of evidence, systematic reviews are the most accurate due to the amount of information processed and the extensiveness of the analysis; therefore, they are credible. In their meta-analysis, Chen et al. (2017) also confirmed the efficacy of donepezil, although they noted that the treatment has more significant effects combined with memantine. In addition, although a small amount of literature determines the effectiveness of donezipil depending on the duration of therapy, all studies measure results after at least 12 weeks. A gradual dose increase at the start of treatment is also recommended by Adlimoghaddam et al. (2018). Thus, all decisions are evidence-based and should benefit the patient.
I was hoping to improve their memory and coordination of Mr. Akkad over time by choosing Aricept (donepezil) because it is an approved drug with evidence of efficacy. According to Adlimoghaddam et al. (2018), “Due to the effect of donepezil for severe end-stage dementia, almost 20-30% of patients acquired cognitive (22%), behavioral (28%), and/or functional (22%) benefit” (p.879). However, Birks and Harvey (2018) demonstrate that 5mg of donepezil’s side effects are less harmful and possible; therefore, it is safer to start treatment with this dosage. Thus, my goal was to test the tolerability of Mr. Akkad. However, I hoped to achieve minor improvements after increasing the dose to 10 mg, although this did not happen. Analysis of the case study and literature made me understand that my expectations were too high for such a short time, and conclusions about the effectiveness of treatment can only be drawn after 12-24 weeks. Thus, although I expected to achieve more significant results, in general, my expectations were in line with the results of the case study.
In conclusion, the treatment of neurocognitive disorder due to Alzheimer’s disease with Aricept (donepezil) is an evidence-based approach. The effectiveness of this approach is supported by several systematic reviews and scientific articles with a high level of evidence. Increasing the dose gradually is also a logical and accepted practice to avoid unwanted side effects. However, treatment takes longer to evaluate its effectiveness and add or discontinue medications.
References
Adlimoghaddam, A., Neuendorff, M., Roy, B., & Albensi, B. C. (2018). A review of clinical treatment considerations of donepezil in severe Alzheimer’s disease.CNS Neuroscience & Therapeutics, 24(10), 876–888. Web.
Birks, J. S., & Harvey, R. J. (2018). Donepezil for dementia due to Alzheimer’s disease. Cochrane Database of Systematic Reviews. Web.
Burke, A.D., Goldfarb, D., Bollam, P. & Khokher, S. (2019). Diagnosing and treating depression in patients with Alzheimer’s disease.Neurology and Therapy, 8, 325–350. Web.
Chen, R., Chan, P.-T., Chu, H., Lin, Y.-C., Chang, P.-C., Chen, C.-Y., & Chou, K.-R. (2017). Treatment effects between monotherapy of donepezil versus combination with memantine for Alzheimer disease: A meta-analysis.PLOS ONE 12(8): e0183586. Web.
Evidence-based medicine (EBM) resources. (n.d.). Web.