Propose An Alternative On-Label, Off-Label, Or Nonpharmacolo
Propose An Alternative On-Label, Off-Label, or Nonpharmacological Treatment for the Disorders
Respond to your colleague. Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature.
Paper For Above instruction
Major neurocognitive disorder due to Alzheimer’s disease (AD) with behavioral disturbances presents a complex therapeutic challenge in older adults, requiring a multifaceted approach that balances efficacy with safety. While pharmacological strategies such as donepezil and risperidone are common, nonpharmacological interventions deserve increased emphasis considering their safety profiles and evidence for efficacy. An alternative approach that merits attention is the use of individualized cognitive stimulation therapy (CST), a nonpharmacological intervention supported by a growing body of research.
CST is a structured, individualized or group-based therapy designed to enhance cognitive and social functioning through activities tailored to the participant's preferences and abilities. It encourages engagement in meaningful cognitive tasks, thereby promoting neural plasticity and cognitive preservation without the risks associated with pharmacotherapy. Several randomized controlled trials have demonstrated the benefits of CST in improving cognition, quality of life, and mood among patients with mild to moderate dementia, including those attributable to AD (Spector et al., 2014; Woods et al., 2012).
Integrating CST into the treatment regimen offers a comprehensive benefit-risk profile. The primary advantage is its safety, as it bears minimal risks and does not interact adversely with medications. It can be implemented across various care settings, including home and institutional environments, making it accessible and adaptable. Moreover, CST fosters social interaction and engagement, which are crucial for reducing behavioral disturbances and enhancing overall well-being, thereby potentially decreasing reliance on pharmacological agents that may cause adverse effects such as sedation or extrapyramidal symptoms (Spector et al., 2014).
In addition to clinical evidence, the guidelines from the National Institute for Health and Care Excellence (NICE) endorse psychosocial interventions like cognitive stimulation therapy for people with mild to moderate dementia, emphasizing their role in promoting cognitive function and quality of life (NICE, 2018). Given the evidence and guideline support, implementing CST as a primary or adjunctive nonpharmacological treatment aligns with current best practices and offers a promising alternative or complement to traditional pharmacotherapy for AD with behavioral disturbances.
Overall, the integration of CST exemplifies a patient-centered, low-risk intervention that supports cognitive health and behavioral management, which should be considered alongside or in lieu of pharmacological treatments, especially given their associated risks in the elderly population.
References
- Spector, A., Thorgrimsen, L., Woods, B., & Orrell, M. (2014). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia: A randomised controlled trial. The Lancet, 378(9800), 1725-1733.
- Woods, B., Aguirre, E., Spector, A., & Orrell, M. (2012). Cognitive stimulation to improve memory in people with dementia. Cochrane Database of Systematic Reviews, (7), CD005562.
- NICE (2018). Dementia: Management and support. National Institute for Health and Care Excellence (NICE). Retrieved from https://www.nice.org.uk/guidance/ng97