The Best Treatments for Alzheimer's Disease

Section A 

Question 1 

Yamasaki et al., (2012) regards Alzheimer’s disease (AD) as a serious condition associated with longevity and the fact that it causes a pressing public health concern. It is the most prevalent type of dementia and affects millions of people across the world. AD is classified as a neurodegenerative disorder characterized by a slow irreversible memory loss and impaired cognitive function. The disease is associated with the loss of neurons. Secondly, the two primary microscopic neuropathological hallmarks that signify the presence of the disease include extracellular amyloid plaques and intracellular neurofibrillary tangles. Yamasaki et al., (2012) noted that research has also shown that the disease is as a result of genetic mutation involving the gene known as apolipoprotein E (APOE). 

Question 2a 

As a complex disease, it is highly unlikely that a single drug will serve as a remedy for AD. The current approaches fundamentally focus on three parts, including the maintenance of mental function, management of behavioral symptoms, and slowing down the disease symptoms. However, the Federal Drug Administration (FDA) has approved certain drugs that could be used in the treatment of the disease. For mild to moderate AD, drugs known as cholinesterase inhibitors are prescribed (Malik & Robertson, 2017). The drugs assist in the reduction of the symptoms and controlling behavioral problems. Examples include galantamine, rivastigmine, and donepezil. The drugs are believed to function by breaking acetylcholine, a chemical known for its role in memory and thinking. For severe AD, the drug of choice is known as N-methyl D-aspartate (NMDA) antagonist. The most common drug in this class is known as Namenda (Malik & Robertson, 2017). 

Question 2b 

The first clinical guideline focuses on the classification of the disease. The three stages of AD include dementia due to Alzheimer's, mild cognitive impairment as a result of Alzheimer's, and thirdly, the preclinical Alzheimer's. The fourth guideline primary focuses on how AD is diagnosed during an autopsy. The guidelines further divide AD into two broad categories, including the preclinical and the clinical stages (Alzheimer's Disease Diagnostic Guidelines). Based on the present scientific evidence, brain changes that characterize AD could have begun much earlier spanning to almost a decade. In the clinical phase, individuals develop signs and symptoms. The guidelines also focus on the definition of the biomarkers, which predict the presence or absence of the disease. Currently, the most significant biomarker for the disease includes brain imaging studies. 

Some of the methods used in the diagnosis of AD include tests to assess memory impairment, judge functional abilities, thinking skills, and the associated behavioral changes. Other tests can be conducted, especially by imaging the brain to rule out any other cause of impairment. Patient education will focus on how well individuals can take care of their emotional and physical health. Patients and their caregivers should be encouraged to attend regular checkups, eat a balanced diet, take medications, exercise frequently, and most fundamentally, avoid intake of alcohol. 

Question 2c 

By and large, the management of AD has been standardized by the diagnostic manual and the FDA. The diagnosis criterion for the management of AD is found in DSM-5. The FDA has also approved certain drugs for the management of the illness. The drugs of choice for the disorder are classified as cholinesterase inhibitors, and the NMDA mentioned earlier. The standard for the management of the disease cut across various jurisdictions and states in the US. 

Question 3 

A patient managing AD well follows both the pharmacological and the non-pharmacological guidelines. Some of the management goals that should be addressed include maintaining the quality of life, maximizing functionality, enhancement of cognition, the safety of the environment, and the promotion of social engagement (Malik & Robertson, 2017). Through nursing facility treatment, the behavioral symptoms, including depression, aggression, agitation, and psychosis, can be controlled. Through the use of the drugs, the symptoms associated with the disease can be controlled effectively. Most patients with AD are elderly who should either live in a nursing home or at home with a caregiver to enhance their access to care. After diagnosis, life expectancy can span between three years to twenty years. 

Question 3a 

The treatment and management of Alzheimer’s at the national and international level follow a similar path. It is based on a combination of drugs and behavioral management. The only difference is that nationally, the drugs are controlled and accredited by the FDA. At the international level, they are standardized by the World Health Organization (WHO). 

Question 4 

Access to healthcare is an essential factor in the management of AD. AD is a disease characterized by spontaneous behavioral changes that could exist in the form of agitation, aggression, and impulsivity (Shaji et al., 2018). Access to healthcare ensures that the patient receives the much-needed care to resolve the problems. Financial resources are also required to manage the drugs and various therapies associated with AD. The disease is prevalent in the elderly, and this might require lengthy stays in hospitals and nursing homes. Therefore, health insurance through Medicaid for the elderly will play a fundamental role in limiting disparities and adverse outcomes. 

Question 4a 

Lack of healthcare shortens the life of the patient. Without financial resources, managing healthcare bills becomes difficult. A lack of an effective health insurance cover means that access to care will become expensive and difficult leading to disproportionate outcomes among populations. 

Question 4.1 

When the disease is not properly managed, first, the patient will exhibit significant mental and cognitive problems such as memory loss and poor judgmental skills. They will experience an emotional and physical breakdown. Most fundamentally, they will develop behavioral problems such as impulsivity, aggressiveness, and agitation. Lastly, their life span significantly reduces. 

Section B 

For the patients, the disease will primarily affect their biopsychosocial welfare. Their physical, psychological, and social parts of life will experience adverse outcomes. Other than the notable health effects, they might find it difficult to establish stable and long-distance relationships with others due to their impulsivity (Shaji et al., 2018). The families will also share the emotional toll that the disease has on the patient. They will suffer financially due to the costs associated with the treatment of the disease. The population will suffer as the senior most part of the society will be eliminated from society, thus denying them their much-needed experience and wisdom. 

Section Ba 

Financial costs that will affect the family will begin with the diagnosis process where imaging and scanning processes could result in high costs. Secondly, the costs of drugs and behavioral management will also tax the family significantly. The community can also be required to make their financial contributions, which will add to the financial toll that the disease has on the people, especially the elderly. 

Section C 

Question a 

The first strategy will focus on enhancing adherence to medication and behavioral therapy. It is through this that these patients will show a positive response that will warrant them a position back into their community settings. The second strategy will emphasize education to ensure that the patient receiving treatment attains the evidence-based skills to manage their conditions, including the behaviors properly. Thirdly, a healthy lifestyle, including exercise, drug-freeness, and a balanced diet will contribute to the much-desired positive outcomes. 

Questions Cb 

Observation will help to gauge the level of implementation when it comes to healthy lifestyles. By collecting reviews through comments and self-reports, one could understand the success in the implementation of education. By reviewing the medical records, the health practitioners will assess the far they have gone with the policy on adherence. 

References 

Alzheimer's Disease Diagnostic Guidelines: National Institute on Aging https://www.nia.nih.gov/health/alzheimers-disease-diagnostic-guidelines 

Malik, G. A., & Robertson, N. P. (2017). Treatments in Alzheimer's disease. Journal of Neurology, 264(2), 416-418. 

Shaji, K. S., Sivakumar, P. T., Rao, G. P., & Paul, N. (2018). Clinical practice guidelines for the management of dementia. Indian journal of psychiatry, 60(Suppl 3), S312. 

Yamasaki, T., Muranaka, H., Kaseda, Y., Mimori, Y., & Tobimatsu, S. (2012). Understanding the pathophysiology of Alzheimer's disease and mild cognitive impairment: A mini-review on fMRI and ERP studies. Neurology research international, 2012.