Prescribing for older with Neurocognitive Disorder: Dementia
discussion response
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:
10.1002/14651858.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.
https://doi.org/10.1016/j.gerinurse.2022.07.012Links 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,
https://www.nice.org.uk/guidance/ng97/chapter/Recommendations#pharmacological-interventions-for- 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/s12325-022-02075-8
Respond
Support your reasoning with at least 2 current, credible scholarly resources.
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
