Miatta Lassanah Johnson Prescribing For Older Adults With Ne
Miatta Lassanah Johnsonprescribing For Older With Neurocognitive Disor
Miatta Lassanah Johnson Prescribing for older with Neurocognitive Disorder: Dementia Acetylcholinesterase (AChE) inhibitors like rivastigmine, galantamine, and donepezil are suggested pharmacologic monotherapy options for managing mild to moderate dementia and Alzheimer's disease (AD) as per the National Institute for Health and Care Excellence [NICE] (2018). For instance, since Donepezil was given FDA approval to treat all phases of AD, practitioners can recommend this medication to treat dementia. Olanzapine, on the other hand, is an off-label medication that may be suggested for the treatment of dementia-related psychosis (Yunusa et al., 2022). An example of nonpharmacological intervention for treating mild to moderate dementia is cognitive group therapy. This therapy involves engaging in a range of group discussions and activities aimed at improving social and cognitive functioning (NICE, 2018). Cognitive group therapy is positively associated with improved cognitive ability, quality of life, and language skills in dementia patients (Chen, 2022). Risks and benefits of medications to treat Dementia It is important to determine whether a patient is currently on any other AChE inhibitors prior to beginning them on Donepezil. If a patient already takes an AChE inhibitor, the provider should consider adding memantine. Only a neurologist, geriatrician, psychiatrist, or other healthcare provider with expertise in the diagnosis and treatment of AD may recommend beginning treatment with Donepezil if the patient is already taking an AChE inhibitor and memantine (NICE, 2018). Donepezil has many advantages which include slight enhancements in daily living activities, and cognitive performance, and it is also cost-effective. However, its disadvantage includes a higher risk of side effects and withdrawal from treatment when the dose is higher than 10 mg/day (Birks & Harvey, 2018). The benefits of Olanzapine as an off-label use include small, non-significant numerical improvements in psychosis scores and a lower likelihood of discontinuation of the medicine. The risk associated with using Olanzapine includes higher odds of mortality and cerebrovascular events (Yunusa et al., 2022). Clinical practice guidelines for dementia When determining the optimal treatment for older patients with dementia, healthcare providers can refer to NICE Guideline for dementia management for people with dementia. This Guideline recommends using Donepezil and cognitive stimulation therapy for dementia patients (NICE, 2018). Nevertheless, it is also useful to refer to research evidence to determine what improvements can be expected from these therapies. References Birks, J.S., & Harvey, R.J. (2018). Donepezil for dementia due to Alzheimer's disease. Cochrane Database of Systematic Reviews. DOI: 10.1002/.CD001190.pub3 Chen, X. (2022). Effectiveness of cognitive stimulation therapy (CST) on cognition, quality of life and neuropsychiatric symptoms for patients living with dementia: A meta-analysis. Geriatric Nursing. to an external site. National Institute for Health and Care Excellence [NICE]. (2018). Dementia: assessment, management, and support for people living with dementia and their carers. NICE guideline [NG97]. Retrieved on January 22, 2023, from, dementiaLinks to an external site. Yunusa, I., Rashid, N., Demos, G.N., Mahadik, B.S., Abler, V.C., & Rajagopalan, K. (2022). Comparative outcomes of commonly used off-label atypical antipsychotics in the treatment of dementia-related psychosis: A network meta-analysis. Advances in Therapy. DOI: 10.1007/s
Paper For Above instruction
Introduction
The management and treatment of neurocognitive disorders, particularly dementia and Alzheimer’s disease (AD), involve a multifaceted approach that combines both pharmacologic and nonpharmacologic interventions. As the global population ages, the prevalence of dementia continues to rise, emphasizing the importance of effective, evidence-based strategies to improve patients' quality of life and functional ability. This paper reviews the current pharmacological treatments, nonpharmacological therapies, associated risks and benefits, and clinical guidelines for managing dementia in older adults, with a focus on acetylcholinesterase (AChE) inhibitors and atypical antipsychotics.
Pharmacological Interventions for Dementia
The primary pharmacologic agents approved for managing mild to moderate dementia, especially AD, are acetylcholinesterase inhibitors such as rivastigmine, galantamine, and donepezil. According to NICE (2018), these medications help improve cognitive function by increasing cholinergic transmission in the brain, which is typically compromised in dementia. Donepezil, in particular, has received FDA approval for use across all stages of AD, making it a widely recommended first-line therapy for dementia management (Birks & Harvey, 2018).
Aside from cholinesterase inhibitors, memantine, an NMDA receptor antagonist, is often added when patients progress to moderate or severe stages of AD, especially if they are already on AChE inhibitors (NICE, 2018). Clinical considerations include reviewing a patient’s current medication regimen to avoid duplications and drug interactions, especially if they are already taking another AChE inhibitor. Just as important is ruling out contraindications, side effects, and medication tolerability to optimize therapeutic outcomes.
Risks and Benefits of Pharmacologic Treatments
Donepezil has demonstrated benefits such as modest improvements in daily living activities, cognitive performance, and behavioral symptoms, with its cost-effectiveness making it a practical option for widespread use (Birks & Harvey, 2018). However, it also carries risks, including gastrointestinal disturbances, bradycardia, and potential withdrawal symptoms, particularly at doses above 10 mg per day. Patients may experience side effects that outweigh benefits, leading to discontinuation.
Olanzapine, an atypical antipsychotic, is used off-label to manage psychosis and behavioral disturbances in dementia, although its use is controversial due to significant safety concerns. Research indicates that olanzapine may lead to slight, statistically non-significant improvements in psychotic symptoms but is associated with higher mortality and increased risk of cerebrovascular events in elderly dementia patients (Yunusa et al., 2022). The use of antipsychotics must therefore be carefully considered, balancing potential symptom relief against these serious risks.
Nonpharmacological Interventions
Nonpharmacologic approaches, such as cognitive stimulation therapy (CST), have been shown to improve cognition, quality of life, and neuropsychiatric symptoms in dementia patients (Chen, 2022). Cognitive group therapy involves structured activities and discussions designed to stimulate memory and social engagement. These interventions target underlying cognitive decline and behavioral disturbances without the adverse side effects associated with medications, making them valuable adjuncts or alternatives, especially in early or mild stages of dementia.
Other nonmedication strategies include environmental modifications to reduce confusion, routine establishment, and caregiver education, which contribute to better management of behavioral symptoms and improve overall well-being for patients and caregivers.
Clinical Practice Guidelines and Recommendations
The NICE guidelines (2018) recommend pharmacologic management with donepezil, galantamine, or rivastigmine for mild to moderate dementia, emphasizing the importance of regular assessment of efficacy and tolerability. These guidelines also recommend combining pharmacotherapy with cognitive stimulation therapy and other supportive measures to optimize patient outcomes. For patients with behavioral symptoms unresponsive to initial medications, clinicians may consider off-label use of antipsychotics like olanzapine, but only after thorough risk assessment and consultation with specialists.
Specialist involvement from neurologists, geriatricians, and psychiatrists is often necessary for complex cases, especially when transitioning between different classes of medications or managing adverse reactions. Regular monitoring for side effects, treatment efficacy, and overall health status remains central to personalized dementia care.
Conclusion
Effective management of dementia in older adults requires a comprehensive approach balancing pharmacologic and nonpharmacologic strategies. Cholinesterase inhibitors such as donepezil are central to current pharmacotherapy, with evidence supporting their modest benefits. Nonpharmacological interventions like cognitive stimulation therapy enhance cognitive and social functions without adverse effects and are recommended as adjuncts. Clinicians must carefully weigh the benefits against potential risks associated with these treatments, especially in the context of the elderly’s comorbidities and polypharmacy. Adhering to clinical guidelines provided by NICE and other authoritative bodies ensures a patient-centered approach that maximizes quality of life for individuals with dementia.
References
- Birks, J.S., & Harvey, R.J. (2018). Donepezil for dementia due to Alzheimer's disease. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/1099-1552(201810)83:10
3.0.CO;2-X - Chen, X. (2022). Effectiveness of cognitive stimulation therapy (CST) on cognition, quality of life and neuropsychiatric symptoms for patients living with dementia: A meta-analysis. Geriatric Nursing.
- National Institute for Health and Care Excellence (NICE). (2018). Dementia: assessment, management, and support for people living with dementia and their carers. NICE guideline [NG97].
- Yunusa, I., Rashid, N., Demos, G.N., Mahadik, B.S., Abler, V.C., & Rajagopalan, K. (2022). Comparative outcomes of commonly used off-label atypical antipsychotics in the treatment of dementia-related psychosis: A network meta-analysis. Advances in Therapy. https://doi.org/10.1007/s12325-022-02181-2
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