Alzheimers Disease (AD) Case Study-Mr Akkad 78 Year Old Man

Alzheimers Disease (AD) Case Study-Mr Akkad 78 Year Old Man

Mr. Akkad, an Iranian man of 76, was brought to my office by his eldest son because of his unusual behavior. His Mini-Mental State Exam score suggested a moderate case of dementia, and his family doctor had ruled out all possible organic causes for his behavior. Mr. Akkad was cordial, helpful, and tangential during the clinical interview. He made awkward eye contact and barely showed any emotion. His ability to think clearly and control his impulses were both compromised. Alzheimer’s disease (assumed) was the cause of his severe neurocognitive dysfunction. After conducting research, I decided that Aricept (donepezil) 5 mg orally at night for decision point 1, Razadyne (galantamine) 4 mg orally BID for choice point 2, and Exelon (rivastigmine) 3 mg orally BID for decision point 3 would be the best course of treatment.

The Wang et al., 2022 study, “Compared of efficacy and safety of high-dose donepezil vs. standard-dose donepezil among elderly patients with Alzheimer’s disease: a systemic review and meta-analysis,” analyzed the results of RCTs that included a total of 5,278 people with Alzheimer’s disease. They found that high-dose donepezil improved cognitive performance in older adults with mild to severe symptoms of Alzheimer’s illness more than standard-dose donepezil.

The second study, “Different Doses of Pharmacological Treatments for Mild to Moderate Alzheimer’s Disease: A Bayesian Network Meta-Analysis,” evaluated the effectiveness, acceptability, and safety of 37 investigations with 14,705 participants total. According to the findings of the meta-analysis, the doses of donepezil at 5 and 10 mg were the best for enhancing mental performance compared to the other investigated treatments (Zhang et al., 2020).

The third Article by Matsunaga et al., 2019, “Efficacy and Safety of Cholinesterase Inhibitors for Mild Cognitive Impairment: A Systematic Review and Meta-Analysis,” was a comparison of the effectiveness and safety of cholinesterase inhibitors on persons with moderate cognitive impairment, based on the findings of a meta-analysis of 14 RCTs with a total of 5,278 participants. The analysis found that cholinesterase inhibitors effectively treat mild cognitive impairment but had severe safety concerns.

In Mr. Akkad’s case, I prescribed donepezil, galantamine, and rivastigmine to slow the progression of his AD, boost his cognitive functioning, and improve his overall functioning. According to data from the Cochrane Database of Systematic Reviews (Birks & Harvey, 2018), donepezil may be helpful for people with mild, moderate, or severe dementia brought on by Alzheimer’s disease because it is linked to minor improvements in cognitive function, daily living skills, and clinician-rated global clinical state. It has also been demonstrated that galantamine helps people with moderate to advanced AD perform better cognitively and generally. Galantamine is often well tolerated by patients. In addition, studies show that rivastigmine helps enhance cognitive and overall functioning and slow the progression of dementia in those with moderate to severe AD.

I initially expected to achieve a certain level of cognitive improvement with the various treatments I prescribed for Mr. Akkad. However, the results of some of the studies had different information than expected. The Wang et al. (2022) study suggested that high-dose donepezil improved cognitive performance more than standard-dose donepezil. The second study (Zhang et al., 2020) also suggested that higher doses of donepezil(10Mg) were more effective than the dose I prescribed at decision point one. Lastly, the third study by Matsunaga et al. (2019) supported the decisions at all the points that cholinesterase inhibitors, such as donepezil, galantamine, and rivastigmine, were effective in treating moderate cognitive impairment, except they have some safety concerns.

References

Matsunaga, S., Fujishiro, H., & Takeuchi, H. (2019). Efficacy and Safety of Cholinesterase Inhibitors for Mild Cognitive Impairment: A Systematic Review and Meta-Analysis. Journal of Alzheimer’s Disease, 71(2), 513–523. https://doi.org/10.3233/jad-190546

Moreta, M. P.-G., Burgos-Alonso, N., Torrecilla, M., Marco-Contelles, J., & Bruzos-Cidón, C. (2021). Efficacy of Acetylcholinesterase Inhibitors on Cognitive Function in Alzheimer’s Disease. Review of Reviews. Biomedicines, 9(11), 1689. https://doi.org/10.3390/biomedicines9111689

Wang, H., Zong, Y., Han, Y., Zhao, J., Liu, H., & Liu, Y. (2022). Compared efficacy and safety of high-dose donepezil vs. standard-dose donepezil among elderly patients with Alzheime