Dementia is a mental condition that robs people of their ability to remember, learn and reason ( Alzheimer's Association, 2016) . The disease can cut a patient from family and friends as well as their sense of self. The client is an elderly Iranian male who is presented for medication due to having strange behavior that is getting worse. His personality has started to change, and he has been losing interested in religious activities and is finding amusement in things he used to take seriously. The purpose of this paper is to discuss the best possible treatment option for treating clients with dementia.
Decision point 1
The first decision is to begin Aricept (donepezil) 5 mg orally at bedtime. Aricept is an oral medication used to treat symptoms of dementia that is caused by Alzheimer’s diseases. It is a reversible inhibitor that increases acetylcholine levels in the brain to provide a reprieve from dementia by improving cognitive and function ( Stahl, 2017). Aricept is effective in treating dementia compared to other options. Razadyne and Exelon were not selected for this patient because of their associated side effects. Razadyne medication often causes an upset stomach and requires the consumption of plenty of water, which could affect the health condition of the patient. At the same time, Exelon may cause upsets in the gastrointestinal part of the patient. The drug also requires taking twice a day and may cause compliance issues.
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The expected result is for the client to return with an improvement in the symptoms of dementia including memory, awareness, and ability to function. As such, it is intended to help the patient back to normal functioning such as attend religious activities. After four weeks of treatment, the client reports that there are no changes or improvement in the symptoms. The client continues to exhibit disinhibited behaviors. This was not the expectation, but it provides a solid base on determining the quantity of the dosage. It, therefore, calls for making the second decision point
Decision point 2
The second decision is to increase Aricept to 10 mg orally at Bedtime. I choose to increase the dosage since the client has not responded to the initial dosage and the expected outcome is yet to be attained. Aricept is usually started at a low dose which is then increased gradually if the client does not respond to the initial treatment ( Meltzer et al., 2010) . Therefore, a change in dosage is required to determine how the client will return to the drug. The expected result for this decision point is an improvement in the symptoms of dementia in the patient.
After four weeks of treatment, the client returns showing some improvements in his condition and tolerating the medication well. He has started to attend religious services with the family and has started to be amused by things he found severe. This shows that the drug has helped in disinhibiting the conditions in the patient. However, there is still a concern on the state of the client as he is showing slight improvement but continues to exhibit the symptoms of dementia. As such, there is a need to make another decision point to help the client achieve full recovery
Decision point 3
The third decision point is to continue Aricept 10 mg orally at bedtime. The decision to maintain the medication is because the client has shown slight improvement and the drug can take several months before stabilizing the deterioration in the patient ( Folstein et al., 2010) . Other options were not considered because the client has shown a positive response to the medication. At this point, no evidence has been demonstrated that increasing the dosage of Aricept past 10 mg per day will have a therapeutic benefit. Instead, increasing the dosage can result in several side effects, and therefore this decision may not be appropriate ( Stahl & Stahl, 2013) . At the same time, there is no reason to discontinue the drug. The expected result for this decision point is that the client reports full recovery from the symptoms of dementia. The changes in the signs should be evaluated after 12 weeks of taking the medication
Ethical consideration
The ethical consideration for this medication is to ensure the drug is appropriate for the client considering his past medical history and cultural aspects. This may include determining whether he has any heart condition, kidney or liver problems or any asthmatic condition since some medicines are not suitable for patients with certain conditions.
Conclusion
Before commencing on any treatment option, it is crucial to assess the state of the client and determine whether the medication will be appropriate in dealing with the symptoms. The best decision point is one that allows the patient to achieve full recovery within a specified period without any side effects. Aricept can improve the condition of the patient by enhancing cognition and function.
References
Alzheimer's Association. (2016). 2016 Alzheimer's disease facts and figures. Alzheimer's & Dementia , 12 (4), 459-509.
Folstein, M. F., Folstein, S. E., McHugh, P. R., & Fanjiang, G. (2010). Mini-mental state examination: MMSE-2 . Psychological Assessment Resources.
Meltzer, H. Y., Mills, R., Revell, S., Williams, H., Johnson, A., Bahr, D., & Friedman, J. H. (2010). Pimavanserin, a serotonin 2A receptor inverse agonist, for the treatment of Parkinson's disease psychosis. Neuropsychopharmacology , 35 (4), 881.
Stahl, S. M. (2017). Prescriber's Guide: Antidepressants: Stahl's Essential Psychopharmacology . Cambridge University Press.
Stahl, S. M., & Stahl, S. M. (2013). Stahl's essential psychopharmacology: neuroscientific basis and practical applications . Cambridge university press.
