Patient 1: 82-year-old male presenting with cognitive decline.

at
Categories
Tags

 

Patient 1: 82-year-old male presenting with cognitive decline. He had always been a very active individual. Over the past year, he has become less active in the community. Previously, he played cribbage weekly with friends at the local senior center but has been struggling with the math involved with the game and no longer attends the weekly card game. He had also volunteered as a crossing guard for the local public school. He quit doing that after he took the wrong turn to get home and drove around the town feeling lost. He acknowledges he is “sensitive” to this and can be irritable towards his children when they bring up these concerns. He was diagnosed with mild neurocognitive disorder after completing neuropsychological testing. Of the following medications, which would be the most appropriate to prescribe? Explain why you chose this medication. What would be the dosing schedule for this patient? Provide education to the patient and review risks, benefits, and potential side effects of the medication. In addition, explain why the other medications listed are not appropriate for this patient. Med List: lorazepam, olanzapine, memantine

Sample Solution

Medication Choice and Education for Patient 1

For this patient with mild neurocognitive disorder, memantine would be the most appropriate medication to prescribe. Here’s why:

Rationale for Memantine:

  • Mechanism of Action: Memantine is an NMDA receptor antagonist. It works by modulating the activity of glutamate, a neurotransmitter involved in learning and memory. By blocking excessive glutamate activity, memantine helps protect brain cells from damage and may improve cognitive function.

  • Specific to Neurocognitive Disorders: Memantine is specifically approved for the treatment of moderate to severe Alzheimer’s disease and is often prescribed for other neurocognitive disorders, including mild neurocognitive disorder. It is not indicated for treating anxiety or other psychiatric conditions.

  • Limited Side Effects: Compared to other medications for cognitive impairment, memantine has a relatively low risk of adverse effects.

Dosing Schedule:

  • Initial Dose: 5mg twice a day for one week.

  • Titration: The dose can be increased to 10mg twice a day after one week, based on the patient’s response and tolerability.

  • Maintenance Dose: The usual maintenance dose is 10mg twice a day.

Patient Education

  • Purpose: “This medication, memantine, is designed to help slow down the decline in your thinking and memory skills.”

  • Benefits: “It may help you improve your concentration, remember things better, and participate in activities you enjoy.”

  • Risks: “While memantine is generally well-tolerated, it can sometimes cause side effects such as dizziness, headache, constipation, confusion, or hallucinations. It’s important to report any unusual symptoms to your doctor.”

  • Dosing Instructions: “You will need to take this medication twice a day, as prescribed. Make sure to take it with food to help with absorption.”

  • Long-Term Use: “This medication is generally taken long-term to manage your symptoms and slow down cognitive decline.”

  • Interactions: “Inform your doctor of any other medications you are taking, including over-the-counter medications and supplements, as they may interact with memantine.”

Why Other Medications are Not Appropriate:

  • Lorazepam: Lorazepam is a benzodiazepine used to treat anxiety. It is not appropriate for treating neurocognitive disorders and can worsen cognitive function.

  • Olanzapine: Olanzapine is an atypical antipsychotic used to treat schizophrenia and bipolar disorder. It is not indicated for cognitive impairment and can cause significant side effects, including weight gain, metabolic syndrome, and cognitive impairment.

Conclusion:

Memantine is a safe and effective medication for treating mild neurocognitive disorder. It is crucial to discuss the benefits, risks, and potential side effects of this medication with the patient, ensuring he understands the proper dosing schedule and reporting any unusual symptoms to his doctor.

This question has been answered.

Get Answer