Posted: October 23rd, 2023
Unit 10 Medications for Dementia
Medications for Dementia
Dementia is a progressive neurological condition characterized by cognitive decline and impairment in daily functioning. As dementia progresses through mild, moderate and severe stages, medications play an important role in managing symptoms to improve quality of life for patients and caregivers. There are two main categories of medications often used to treat different stages of dementia – NMDA receptor antagonists and cholinesterase inhibitors.
NMDA receptor antagonists work by regulating glutamate activity in the brain. Glutamate is a neurotransmitter involved in processes like learning and memory (Mayo Clinic, 2022). One drug in this class is memantine, which is sometimes prescribed for moderate to severe dementia. Memantine works by blocking the NMDA receptor and inhibiting excess glutamate activity, which can damage neurons (Mayo Clinic, 2022). By modulating glutamate signaling, memantine can help reduce agitation, aggression and other behavioral symptoms in later stages of dementia.
The other primary drug category is cholinesterase inhibitors (ChEIs). ChEIs work to modify the progression of dementia by inhibiting the breakdown of acetylcholine, an important neurotransmitter for memory and cognition (Mayo Clinic, 2022). Common ChEIs prescribed for mild to moderate dementia include donepezil, rivastigmine and galantamine. By preventing the breakdown of acetylcholine, these drugs can temporarily stabilize or modestly improve cognitive symptoms. Donepezil is one of the most widely used ChEIs and has been shown to improve cognition, function and behavior in Alzheimer’s patients for up to 12 months (Feldman et al., 2005).
Diagnostic tests can help physicians determine the appropriate stage and severity of a patient’s dementia to guide medication selection and management. Standardized cognitive assessments like the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) evaluate domains impacted by dementia like memory, language and executive function (Alzheimer’s Association, 2022). Scores on these tests can indicate mild, moderate or severe impairment. For example, Mrs. Outcome’s scores suggest moderate dementia based on her performance being between 10-18 on the MMSE (Alzheimer’s Association, 2022).
It is important for physicians to distinguish dementia from other conditions with similar symptoms like delirium. While delirium has an acute onset caused by a medical issue and fluctuating course, dementia gradually worsens over months to years due to underlying neurological degeneration (Fong et al., 2016). Proper diagnosis allows for targeted treatment of the underlying cause in delirium versus management of progressive cognitive and functional decline in dementia.
In summary, NMDA receptor antagonists and cholinesterase inhibitors are the primary drug classes used to treat different stages of dementia based on diagnostic evaluations. Medications can help control symptoms to optimize quality of life as the condition gradually progresses. Further research continues to explore new drug targets and development of more effective therapies to modify disease progression.
Alzheimer’s Association. (2022). Medical tests for diagnosing Alzheimer’s. https://www.alz.org/alzheimers-dementia/diagnosis/medical_tests
Feldman, H., Gauthier, S., Hecker, J., Vellas, B., Subbiah, P., & Whalen, E. (2005). Efficacy of donepezil on maintenance of activities of daily living in patients with moderate to severe Alzheimer’s disease and the effect on caregiver burden. Journal of the American Geriatrics Society, 53(2), 211–217. https://doi.org/10.1111/j.1532-5415.2005.53107.x
Fong, T. G., Davis, D., Growdon, M. E., Albuquerque, A., & Inouye, S. K. (2016). The interface of delirium and dementia in older persons. Lancet neurology, 15(8), 823–831. https://doi.org/10.1016/S1474-4422(16)00194-8
Mayo Clinic. (2022). Dementia. https://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-20352019
Unit 10 Medications for Dementia. 800w. 4 references. Due 10-28-23
Mrs. Taylor Outcome is a 73-year-old female currently living at her own residence; however, her daughter is worried that Mrs. Outcome may be “losing it” after she left a burner on and caused a small fire in her house. After this event, Mrs. Outcome’s daughter, Teresa, stayed with her mother to make sure she was “all right”. Teresa noted that during the night her mother once yelled out “help me, help me.” Teresa also noted some confusion between day and night evidenced by her mother sleeping in the day and staying up at night.
Mrs. Outcome and her daughter arrive at your practice. As is standard, you have the nurse perform some standardized tests.
The scores on her tests are listed below:
• FAQ = 13/30
• GAD-7 = 7/21
• PHQ-9 = 8/27
• MMSE = 20/30
• Clock drawing test = 2/5
Please answer the following questions about Mrs. Outcome.
1. Based on the test scores above, do you believe that Mrs. Outcome does have dementia?
2. What are the differences between delirium and dementia?
3. What two categories of medications are often used to treat dementia and how do these medications work?
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with in-text citations and corresponding references in APA format.
Please only use this as a guide as the instructor checks for plagiarism. Use the textbook Thank you
Based on the results of the test scores above, Mrs. Outcomes have moderate dementia. This is clarified by the scores in the standardized tests above. For example, The FAQ(Frequently Asked Questions) indicates a score of 13 out of 30. According to the scoresheet, a score of between 13 to 20 indicate moderate dementia.(Alzheimer’s Association, 2022). The GAD(Glutamic Acid Decarboxylase Autoantibodies) tests of 7 out of 21 indicates moderate dementia. This is because according to the score tests of 21 any score between 6 to 10 indicates moderate dementia. PHQ-9 has a scale form 0 to 24. the scores are interpreted with cut points which has different interpretations for example, it has cuts points of 5, which is mild, 10, which is moderate, 15 which is moderately severe and 20 which is severe condition.(Kurt Kroenke, et al. 2001). Therefore, in this case Mrs. Outcome has moderate dementia because her cut point scores lies at 10. Additionally, the MMSE(Mini-Mental State Exam) test is used to test the cognitive functioning of the elderly. In this case, the test scores indicates moderate dementia. That is, a score of 0 to 12 indicates severe, 13 to 20 suggests a moderate dementia and a score of 20 to 24 indicates 24 indicates mild dementia as explained by Alzheimer’s Association(2022). Lastly the Clock-drawing tests is used to determine the mental performance by asking the patient to draw a clock and place all number in place. In this case Mrs. Outcome scores 2 out of 5 which suggests mild to moderate dementia.
It would be important to note that Delirium and dementia are mental health conditions which different characteristics and manifestation. Delirium is commonly caused by factors such as drug toxicity or event of acute illness. In most cases, delirium manifests in signs and symptoms that occurs suddenly and changes frequently within a short time. This condition is reversible although it can be fatal if not managed early.
on the other hand, dementia is a mental condition that occurs due to anatomical changes in the brain which takes time to manifest. this condition is irreversible in nature and can only be managed and controlled. However, the manifestation of delirium could be mistaken as dementia but the main difference is that dementia is slow but regressive.(Tamara G. Fong, et al. 2016).
The two commonly used drug category to treat dementia includes the N-methyl-D-aspartate receptors (NMDA). For example memantine, amantadine and dextromethorphan. These drugs work by inhibiting the actions of glutamate by binding to the glutamate site in the N-methyl-D-aspartate antagonists receptors. This helps in opening the ion-channel.(Mayo Clinic, 2022). Secondly, Cholinesterase inhibitors (ChEIs) is another category that is used to treat dementia in its moderate level. This category includes drugs such as galantamine, rivastigmine and donepezil. The ChEIs work to modify the manifestation of dementia conditions or the Alzheimer’s which is associated with dementia. This occurs when the ChEIs drugs inhibit the breakdown of acetylcholine chemical in the rain this chemical is an important components in neurotransmission which is associated with memory as explained by Mayo Clinic(2022).
Additionally, dementia is condition that is progressive meaning that it would take months to years to start seeing the sign and symptoms of the conditions. However, the conditions progress in stages which starts from mild, moderate, severely moderate and severe depending on the characteristics of the manifestation and standard tests scores. In this case, the tests cores for Mrs. Outcome indicates moderate dementia. This is because in most scores of the standard tests indicate so as described above. However, these condition can be mistaken with delirium. This is because they have similar sign and symptom. The differential characteristics between the two is that, Delirium occurs suddenly and takes hours to days while dementia takes months to years to manifest. Delirium is most associated with acute mental illness and drug toxicity accumulation in the brain hence affecting how the brain functions when it it comes to its cognitive functions. On the other hand, dementia is caused with anatomical modifications and conditions such as the Alzheimer’s disease. This condition is irreversible is nature but can be treated and managed when realized earlier enough.
1. Medical Tests for Diagnosing Alzheimer’s By Alzheimer’s Association, (2022). Link: https://www.alz.org/alzheimers-dementia/diagnosis/medical_tests#:~:text=During%20the%20MMSE%2C%20a%20health,than%2012%20indicates%20severe%20dementia.
2. The PHQ-9; Validity of a Brief Depression Severity Measure By Kurt Kroenke, Robert L Spitzer, and Janet B W Williams, (2001). Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495268/
3. The Interface of Delirium and Dementia in Older Persons By Tamara G. Fong, PhD, Daniel Davis, PhD, Matthew E. Growdon, Asha Albuquerque, and Sharon K. Inouye, (2016). Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4535349/
4. Dementia By Mayo Clinic, (2022). Link: https://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/drc-20352019