In this discussion, we select a specific vulnerable population of either pregnant women or older adults. The population chosen is older adults. DSM-5 will be used to describe the disorder. The disorder selected was Dementia. Dementia, also referred to as major neurocognitive disorder, is a severe impairment in memory, judgment, orientation, and cognition (Sadock, Sadock & Ruiz, 2015). of all patients with dementia, 50 to 60 percent have the most common type known as Alzheimer’s disease (Sadock, Sadock, & Ruiz, 2015). According to the American Psychiatric Association (2013), the criteria for Dementia in their book “Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The criteria for Dementia are as followed:
A. Evidence of significant cognitive decline. This decline must be measure from previous levels of performance in one or more of the designated cognitive domains. These domains are social cognition, perceptual-motor, complex attention, executive function, language, and learning and memory.
B. The cognitive decrease or deficits for the individual inhibits the individuals’ daily activities and independence (American Psychiatric Publishing, 2013).
C. The noted cognitive deficits are not just associated with delirium (American Psychiatric Publishing, 2013).
D. The deficits in cognition are not explained by other mental health disorders (American Psychiatric Publishing, 2013).
According to Sadock, Sadock & Ruiz (2015), When prescribing psychotropic medication for geriatric patients, the general rule is to begin with the lowest dose possible to achieve the desired therapeutic outcome. A proverb in geriatric medicine regarding the use of drugs is: Start low, go slow (Sadock, Sadock & Ruiz, 2015). In case the patient has exhibited all these characteristics. Drug therapy is the most common and most successful treatment for Dementia. The five most common drugs are Donepezil, Galantamine, Rivastigmine, and Tacrine. The selected FDA-approved drug is Rivastigmine, classified acetylcholine enzyme inhibitor, cholinesterase inhibitor & cognitive enhancer (Stahl, 2017). The off-label drug I would use is Selegiline, a selective type B monoamine oxidase (MAO) inhibitor (Stahl, 2017). It works by irreversibly inhibiting MAO-A and MAO-B from breaking down norepinephrine, serotonin, and dopamine, which boost noradrenergic, serotonergic, and dopaminergic neurotransmission (Stahl, 2017). Selegiline can also enhance the action of levodopa in Parkinson’s disease which a few weeks of starting the dose. Drug-related side effects include headaches, insomnia, diarrhea, dry mouth, dizziness, dyskinesia, confusion, hallucination. In elderly adults using Selegiline, caution should be made, and the patient should be observed for postural changes in blood pressure or orthostatic hypotension, resulting in falls. It is commonly prescribed for major depressive disorder, but some studies have found that it helps slow the advance of Dementia (Sadock, Sadock, and Ruiz, 2015)
Alternatives to traditional drug therapy are dietary changes that increase healthy foods such as blueberries, turmeric, and avocados that have been linked to slowing cognitive decline cognition (The top five dementia medications for seniors, 2021). Exercise that produces hormones known to battle the disorder. It has been found that individuals who exercise produce brain-derived neurotrophic factors that improve cognition (The top five dementia medications for seniors, 2021). The risk assessment for Dementia should include family history. Dementia has a significant genetic element to the risk of developing Dementia. The second assessment is a quick verbal fluency test call the Mini-Cognitive Assessment instrument. Those with abnormal results should have a formal cognitive test.
The use of Rivastigmine has pros and cons. The side effects are some of the cons. The side effects are nausea, vomiting, loss of appetite, stomach pain, constipation, diarrhea, headache, dizziness, and fatigue (Stahl, 2017). In some cases, the individual could overdose by taking too many pills. In addition, some people have more severe side effects such as aggressive behavior or more life-threatening and dangerous side effects, including rare seizures or rare syncope (Stahl, 2017).
There is a clinical guideline for Dementia. Decline Partnership Center (2016) provides guidelines to care based on evidence-based practices evaluated in a systematic review. It states that the diagnosis should only be given after a comprehensive assessment. A thorough laboratory workup must be performed during the patient evaluation to detect reversible causes and provide the patient and family with a definitive diagnosis (Sadock, Sadock, & Ruiz, 2015). Recurrent cognitive assessment and review of medication are needed to ensure the effectiveness of the treatment regimen. According to Shaji et al. (2019), guidelines measures also include management of delirium superimposed on dementia, management of multi-morbidity, prevention of falls, the need to link with community outreach services, and use of diagnosis instruments.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders DSM-5 (5th ed). Arlington, VA. American Psychiatric Publishing.
Decline Partnership Center (2016). Clinical Guidelines and Principles of Care for People with Dementia. Retrieved from https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/CDPC-Dementia-Guidelines_WEB.pdf
Sadock, B. J., Sadock, V. A., Ruiz P. (2015). Kaplan & Sadock’s Synopsis of Psychiatry Behavioral Science/Clinical Psychiatry (11th ed). Philadelphia, PA: Lippincott Williams & Wilkins.
Stahl, S. M. (2017). Stahl’s essential psychopharmacology prescriber’s guide (6th ed.). Cambridge University Press.
Shaji, K. S., Sivakumar, P. T., Rao, G. P., & Paul, N. (2018). Clinical Practice Guidelines for Management of Dementia. Indian journal of psychiatry, 60(Suppl 3), S312–S328. https://doi.org/10.4103/0019-5545.224472
The top five dementia medications for seniors. AssistedLiving.org. (2021, June 15). https://www.assistedliving.org/the-top-five-dementia-medications/#treating_dementia.
Vallerand, A. H., Sanoski, C. A., Deglin, J. H., & Mansell, H. G. (2015). Davis’s drug guide for nurses. Philadelphia, PA: F.A. Davis