Alzheimer's Essay

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This paper is going to discuss on how to manage a male 67 years old patient, Mr Wong, who is admitted into a nursing home and suffering from a cognitive disorder, Alzheimer’s disease, late moderate stage by implementing pharmaceutical intervention and two multidisciplinary team (MDT) management plans. Alzheimer’s disease (AD) is defined under DSM-IV criteria as a progressive neurodegenerative disorder and is characterized by the development of multiple cognitive deficits (Cummings, 2001; Cummings & Khachaturian, 1996). AD usually happens with increasing age, especially over the age of 65 as well as genetics related (DeKosky, 2001; Blass & Poirier, 1996). The incidence of getting AD in the population is about 1% to 4% per year (DeKosky, 2001). The diagnosis of AD is complex and it may require many visits to different specialists over several months before the diagnosis can be confirmed (Sims, Odle & Davidson, 2009). The few common laboratory test that is able to indicate the present of AD are blood and urine test, brain tomography (MRI), positron emission tomography (SPECT) scans and tests of the brain’s electrical activity (electroencephalographs or ECGs) (Sims, Odle & Davidson, 2009). Even so AD cannot be diagnosed conclusively until an autopsy examination is done for the examination of the brain for plaques and neurofibrillary tangles (Sims, Odle & Davidson, 2009). AD can be categorised into two main categories. The first category is the deficits in the metabolism of neurotransmitter that is acetylcholine (ACh) which is required for the short memory function (DeKosky, 2001). The second category is the structural changes in the brain (DeKosky, 2001). It can be either structural loss or alteration of the structure that affects the cortex of the brain that is responsible for the short term memory (DeKosky, 2001). Regardless which category AD patients are suffering, they would display certain characteristics that are indicative of AD. They are memory abnormalities, language abnormalities or aphasia, visuospatial and other intellectual deficits or agnosia, neuropsychiatric alterations and motor system abnormalities or apraxia (Cummings, 1990; Grainger & Keegan, 2011; Maier-Lorentz, 2000). The characteristics have negative impacts on the individual’s quality of life (QoL) which is able to affect the activities of daily living (ADLs) of the individuals, such as incontinence, unable to maintain proper personal hygiene and grooming and unable to dress and undress (Logsdon, gibbons, McCurry & Teri, 2000). Other than affecting the ADLs of the individuals, AD affects the behaviour of the individual such as wandering, sleep disturbances, delusion and hallucination, depression and catastrophic reaction (Maier-Lorentz, 2000). AD patients are usually taken care by their caregivers who are usually their family or the community (Maheu & Cohen, 1996).However, due to the progressiveness and the negative impacts of the disease to the individual, it makes the care difficult for the caregivers. The caregivers may feel fatigue and overwhelmed by the enormous and prolonged demands of the AD patients (Maheu & Cohen, 1996). This may even lead to depression in the caregivers (Maheu & Cohen, 1996). In Mr Wong’s case, he has both ADL deficit and behavioural problem which is too tedious for his family to take care of him anymore. Hence, in order to slow down the progression of the disease and to better manage Mr Wong’s ADLs deficit and behavioural problem MDT management plans should be implemented. The first line treatment of AD is pharmaceutical intervention which is prescribed by the doctor. The first line drug used for all AD patients is cholinesterase inhibitors. Cholinesterase inhibitor is a chemical that inhibits the intrasynaptic cholinesterase enzyme from breaking down acetylcholine increasing both the level and duration of action of neurotransmitter acetylcholine. They can be either reversible or...
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