Advanced Psychopharmacology and Health Promotion
Unit 10 Peer response. Medications for Dementia. 800W. APA. 4 references due 10-10-23.
Please read and respond to at least two of your peers’ initial postings. You may want to consider the following questions in your responses to your peers:
- Compare and contrast your initial posting with those of your peers.
- How are they similar or how are they different?
- What information can you add that would help support the responses of your peers?
- Ask your peers a question for clarification about their post.
- What most interests you about their responses?
Please be sure to validate your opinions and ideas with citations and references in APA format.
Week 10, Medications for Dementia
Based on the test scores above, do you believe that Mrs. Outcome does have dementia?
Dementia is characterized by a significant cognitive dysfunction from patients’ usual functioning level, impacting their daily activities and quality of life (Stahl, 2021). The Functional Activity Questionnaire (FAQ) is a validated instrument used to assess functional activity levels in older adults. It evaluates activities that require advanced skills, such as managing finances or preparing meals. The purpose of this questionnaire is to identify individuals with functional impairments, particularly in the elderly population (Vik et al., 2023). Mrs. Outcome’s score of 13/30 suggests that she is experiencing disruptions in her daily functioning and may be dealing with cognitive issues.
The GAD-7 scale (Generalized Anxiety Disorder 7-item scale) is a validated tool that is increasingly utilized for screening and clinical research. It is applicable to both adults and adolescents, in both general population and individuals with anxiety disorders. This scale consists of seven items and is designed to evaluate the level of anxiety in patients (Todorović et al., 2023). Mrs. Outcome’s score of 7/21 suggests she is experiencing mild anxiety.
The Mini-Mental Status Examination (MMSE) has a maximum score of 30 points, with higher scores indicating better cognitive function. It comprises 11 questions that assess aspects such as orientation to time, orientation to place, immediate memory, serial seven calculation, delayed memory, naming, repetition, oral instruction, writing instruction, spontaneous writing, and copying a design (Naito et al., 2023). Mrs. Outcome’s score of 20/30 suggests mild cognitive impairments. Given Mrs. Outcome medical history, which includes incidents like “losing it,” a fire in her house, and confusion between day and night, there is a clear decline from her previous level of functioning. The test results also indicate cognitive decline. Mrs. Taylor is indeed experiencing some degree of cognitive issues, which could be indicative of dementia
What are the differences between delirium and dementia?
Delirium and dementia differ in several ways. Delirium is a sudden-onset neuropsychiatric condition triggered by a medical issue. Delirium is characterized by disturbances in consciousness and cognitive function, with fluctuating symptoms, often affecting vulnerable individuals (Heijden et al., 2023). On the other side, dementia has a gradual onset and progresses over time (Stahl, 2021). While delirium is typically linked to a patient’s medical conditions, often occurring in hospitals, and may be reversible if the underlying cause is resolved, dementia is usually progressive and generally not reversible. In delirium, patients experience impaired attention and reduced awareness of their environment, while those with dementia typically have relatively preserved attention and stable awareness. Dementia primarily affects memory and other cognitive areas in the early stages. Delirium can lead to impairments in various cognitive areas, including memory, language, and executive functions. Dementia patients have a higher risk of developing delirium compared to the general population (Fong & Inouye, 2022).
What two categories of medications are often used to treat dementia and how do these medications work?
As per Stahl (2021), there are two main groups of medications that can help patients with dementia. The first group is Cholinesterase inhibitors, including medications like donepezil, rivastigmine, and galantamine. Cholinesterase inhibitors work by inhibiting the enzyme responsible for breaking down acetylcholine, a key neurotransmitter that is often reduced in dementia patients. This group of medications functions by increasing acetylcholine levels, which can improve cognitive function, particularly in the early stages of Alzheimer’s disease. Galantamine, a cholinesterase inhibitor, was initially derived from snowdrops and has a unique mechanism of action, involving both the inhibition of cholinesterase and the regulation of nicotinic cholinergic receptors (Stahl, 2021).
The second group of medications consists of NMDA receptor antagonists, with memantine being a prominent example. These medications modulate the activity of glutamate, another neurotransmitter with a crucial role in learning and memory processes. By controlling glutamate levels, these medications may slow down the progression of dementia symptoms, particularly in cases of moderate to severe dementia (Stahl, 2021).
Fong, T. G., & Inouye, S. K. (2022). The inter-relationship between delirium and dementia: the importance of delirium prevention. Nature Reviews. Neurology, 18(10), 579-596. https://doi.org/10.1038/s41582-022-00698-7
Heijden, E. F. v. d., Kooken, R. W. J., Zegers, M., Simons, K. S., & van den Boogaard, M. (2023). Differences in long-term outcomes between ICU patients with persistent delirium, non-persistent delirium and no delirium: A longitudinal cohort study. Journal of Critical Care, 76https://doi.org/10.1016/j.jcrc.2023.154277
Naito, T., Suzuki, Y., Yamasue, K., Saito, K., Umemura, M., Kojima, N., Kim, H., Osuka, Y., Ishikawa, Y., & Tochikubo, O. (2023). Relationship between cognitive function and sway of body in standing posture: A cross-sectional study. Geriatrics, 8(2), 29. https://doi.org/10.3390/geriatrics8020029Links to an external site.
Stahl, S. M. (2021). Stahl’s essential psychopharmacology: Neuroscientific basis and practical application (5th ed.)
Todorović, A., Baumann, C., Blanchin, M., & Bourion-Bédès, S. (2023). Validation of Generalized Anxiety Disorder 6 (GAD-6)—A Modified structure of screening for anxiety in the adolescent French population. International Journal of Environmental Research and Public Health, 20(8), 5546. https://doi.org/10.3390/ijerph20085546
Vik, A., Kociński, M., Rye, I., Lundervold, A. J., & Lundervold, A. S. (2023). Functional activity level reported by an informant is an early predictor of Alzheimer’s disease. BMC Geriatrics, 23, 1-15. https://doi.org/10.1186/s12877-023-03849-7
Unit 10 – Medications for Dementia
- Based on the test scores above, do you believe that Mrs. Outcome does have dementia?
Considering the test results given it seems probable that Mrs. Outcome is experiencing dementia. The score of 20/30, on the NMSE indicates cognitive impairment (Korsnes, 2020). The clock drawing test score of 2/5 indicates challenges with visuospatial abilities, which are often affected in individuals with dementia (Palsetia et al., 2018). Furthermore, her FAQ score of 13/30 suggests that she is experiencing functional impairment in daily activities (Gonzalez et al., 2022). The GAD-7 and PHQ-9 scores indicate mild levels of anxiety and depression which are often seen in individuals with dementia (Stocker et al., 2021). Taking into account these scores, along with other observations like confusion regarding day and night, calling out for assistance, and daytime sleepiness it seems likely that she may be dealing with dementia.
- What are the differences between delirium and dementia?
Delirium and dementia are two conditions that can lead to cognitive impairment and have notable distinctions. Delirium typically manifests suddenly and exhibits fluctuating symptoms often triggered by a medical condition or medication side effect. It can usually be reversed by addressing the underlying cause (Grover & Avasthi, 2018). In contrast, dementia refers to a progressive deterioration in cognitive abilities over time and is irreversible (Duong et al., 2018).
- What two categories of medications are often used to treat dementia and how do these medications work?
There are two types of medications that are commonly used for treating dementia: cholinesterase inhibitors and N methyl D aspartate (NMDA) receptor antagonists. Cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine work by increasing the levels of acetylcholine in the brain, which helps improve cognitive function to some extent (Battle et al., 2021). On the other hand, NMDA receptor antagonists like memantine help regulate glutamate activity in the brain and may slow down the progression of symptoms associated with moderate-to-severe Alzheimer’s disease (Wang et al., 2018). According to the World Health Organization, Alzheimer’s disease is the major cause of dementia, for approximately 60–70% of cases. This chronic neurodegenerative condition exhibits a progression of symptoms over time starting with forgetfulness and gradually affecting language skills, orientation, and behavior, and leads to severe loss of memory and impairment of certain bodily functions until the ultimate death (Wang et al., 2018).
Battle, C. E., Abdul-Rahim, A. H., Shenkin, S. D., Hewitt, J., & Quinn, T. J. (2021). Cholinesterase inhibitors for vascular dementia and other vascular cognitive impairments: A network meta-analysis. Cochrane Database of Systematic Reviews, 2021(2). https://doi.org/10.1002/14651858.cd013306.pub2Links to an external site.
Duong, S., Patel, T., & Chang, F. (2018). Dementia. Canadian Pharmacists Journal / Revue des Pharmaciens du Canada, 150(2), 118–129. https://doi.org/10.1177/1715163517690745Links to an external site.
González, D., Gonzales, M. M., Resch, Z. J., Sullivan, A., & Soble, J. R. (2021). Comprehensive evaluation of the functional activities questionnaire (faq) and its reliability and validity. Assessment, 29(4), 748–763. https://doi.org/10.1177/1073191121991215Links to an external site.
Grover, S., & Avasthi, A. (2018). Clinical practice guidelines for management of delirium in elderly. Indian Journal of Psychiatry, 60(7), 329. https://doi.org/10.4103/0019-5545.224473Links to an external site.
Korsnes, M. (2020). Performance on the mini-mental state exam and the montreal cognitive assessment in a sample of old age psychiatric patients. SAGE Open Medicine, 8, 205031212095789. https://doi.org/10.1177/2050312120957895Links to an external site.
Palsetia, D., Rao, G., Tiwari, S. C., Lodha, P., & De Sousa, A. (2018). The clock drawing test versus mini-mental status examination as a screening tool for dementia: A clinical comparison. Indian Journal of Psychological Medicine, 40(1), 1–10. https://doi.org/10.4103/ijpsym.ijpsym_244_17Links to an external site.
Stocker, R., Tran, T., Hammarberg, K., Nguyen, H., Rowe, H., & Fisher, J. (2021). Patient health questionnaire 9 (phq-9) and general anxiety disorder 7 (gad-7) data contributed by 13,829 respondents to a national survey about covid-19 restrictions in australia. Psychiatry Research, 298, 113792. https://doi.org/10.1016/j.psychres.2021.113792Links to an external site.
Wang, R., & Reddy, P. (2018). Role of glutamate and nmda receptors in alzheimer’s disease. Journal of Alzheimer’s Disease, 57(4), 1041–1048. https://doi.org/10.3233/jad-160763Links to an external site.