Neurocognitive Disorders Discussion paper

The client, Mr. Wingate is a 76-year-old man who presents for assessment manifesting symptoms of the neurocognitive disorder. Accordingly, this paper seeks to perform a differential diagnosis for the client, and select the appropriate treatment plan for psychotherapy and psychopharmacology. Finally, the ethical factors that may influence the client’s treatment plan and communication with the family will be discussed. Neurocognitive Disorders Discussion paper

Decision #1: Differential Diagnosis

The selected decision is that the diagnosis of the client is major frontotemporal neurocognitive disorder (FTNCD). This is because the client manifests the majority of symptoms in FTNCD. According to the DSM-5, a diagnosis for major neurocognitive disorder should include insidious onset and gradual progression of the disturbance; behavioral variant manifested by behavioral inhibition; compulsive behavior or even lack of empathy. In FTNCD, there is also a significant deterioration of social cognition or executive skills, as well as manifestation of language defects (Young et al, 2018). The client Mr. Wingate manifests a decline of performance level when it comes to executive function and this may be an indication of FTNCD. The decline in cognition is manifested by the client’s inability to perform activities of daily living such as medication intake, forgetting to pay his bills, as well as forgetting that he was cooking. There is also cognitive decline for Mr. Wingate as expressed by his Mark, who is a reliable informant. However, to confirm the diagnosis of FTNCD, it would be appropriate to conduct further tests such as neurobiology and neuroimaging (Young et al, 2018). It will also be essential to perform a genetic testing to confirm if genetic mutation may be causing the symptoms for Mr. Wingate (Hugo & Ganguli, 2014).

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Decision #2: Treatment Plan for Psychotherapy

The selected decision point two is to start Memantine 5 mg orally daily. The reason for selecting Memantine is because the medication functions by hindering the action of glutamate in the brain; glutamate is associated with symptoms associated with the neurocognitive disorder (Avasthi et al, 2016). Therefore, memantine is thus effective in improving memory, awareness, as well as an individual ability to carry out activities of daily living. Studies also show that memantine improves cognition (Khondoker et al, 2018). Mr. Wingate manifests a decline in memory function, cognition decline as well as reduced ability to perform activities of daily living; this provides a rationale for selecting memantine for the client.

It was expected that by administering memantine to the client, his memory would improve as well as his ability to perform activities of daily living. It was also expected that the client would experience minimal side effects from the medication. This is because the medication has been shown to be effective in improving cognition and memory, as well as in improving the ability to perform activities of daily living (Khondoker et al, 2018). Neurocognitive Disorders Discussion paper

The outcome of the decision included minimal side effects as manifested by medication tolerability. There was also an improvement in regard to the alarming nightmares even though they occasionally occur. However, there was no improvement in memory. The lack of improvement in memory is because memantine prevented deterioration of neuro-degeneration but did not treat the already present defects (Avasthi et al, 2016). Therefore, Mr. Wingate may continue manifesting symptoms such as memory loss but with Memantine the symptoms may not worsen.

Decision #3: Treatment Plan for Psychopharmacology

The selected decision is the addition of Donepezil 5 mg orally at bedtime. Donepezil was chosen because it is an acetylcholinesterase inhibitor that causes levels of acetylcholine to increase and this improves cholinergic transmission; this is beneficial to individuals with cholinergic deficits such as individuals with neurocognitive disorders. As a result, such patients get modest improvements when it comes to performing activities of daily living, behavior, and cognitive function. Donepezil should be administered at bedtime due to its sedative effects.

Addition of donepezil for the client is expected to further improve the existing symptoms for the client, such as improved cognitive function and improved ability to perform activities of daily living.

Impact of Ethical Considerations that might impact Treatment Plan

Ethical factors such as the ability to make decisions, informed consent, and autonomy may impact the client’s treatment plan (Alicia et al, 2015). This is because sometimes individuals with major cognitive deficits such as Mr. Wingate may lack the ability to make decisions regarding their treatment. In such a case, family members may be involved in the client’s treatment plan (Alicia et al, 2015). Similarly, Mr. Wingate may not understand the treatment regimen because of the impaired cognition and hence a family member like Mark may be the one to consent to treatment. Neurocognitive Disorders Discussion paper

Conclusion

The diagnosis for the client is frontotemporal neurocognitive disorder (FTNCD). This diagnosis was selected because Mr. Wingate manifests some of the symptoms present in FTNCD. The selected decision for the client’s treatment plan for psychotherapy is to start Memantine 5 mg orally. This decision was selected because memantine has been shown to be effective in improving memory, and the ability to perform activities of daily living. the third decision was to add donepezil 5 mg orally at bedtime. Addition of donepezil was selected because the medication improves cholinergic transmission and hence effective in improving symptoms such as cognitive function and capability to perform activities of daily living. Finally, ethical aspects such as decision-making capacity and informed consent may impact the client’s treatment plan.

References

Alici Y, Dunn L & Weiss R. (2015). Ethical Challenges in the Treatment of Cognitive Impairment in Aging. Current Behavioral Neuroscience Reports. 2(4), 226-233.

Avasthi A, Gupta G & Grover S. (2016). Pharmacotherapy of dementia. Journal of Geriatric Mental Health. 3(1), 66-79.

Khondoker K, Magil N, Stewart R & Landau S. (2018). A Systematic Review and Meta-Analysis of the Effectiveness of Acetylcholinesterase Inhibitors and Memantine in Treating the Cognitive Symptoms of Dementia. Dementia Geriatric Cognitive Disorders. 1(45):131–151.

Hugo J & Ganguli M. (2014). Dementia and Cognitive Impairment: Epidemiology, Diagnosis, and Treatment. Clin Geriatr Med. 30(3): 421–442.

Young J, Lavakumar M, Tampi D, Silpa B & Tampi R. (2018). Frontotemporal dementia: latest evidence and clinical implications. Ther Adv Psychopharmacol. 8(1): 33–48. Neurocognitive Disorders Discussion paper

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