Neurocognitive Disorders Sample Research

Introduction

The focus of the case study is Mr. Charles Wingate, 76 years old man who manifests symptoms of neurocognitive disorders. This paper will center on making a differential diagnosis for the client, secondly selecting a decision regarding his treatment plan for psychotherapy and thirdly selecting a treatment plan for psychopharmacology. Finally, ethical aspects that may affect the client’s treatment plan will be discussed. Neurocognitive Disorders Sample Research

Decision #1: Differential Diagnosis

The selected decision is that Mr. Wingate’s diagnosis is major neurocognitive disorder with Lewy bodies. The rationale of selecting this decision is because the client’s symptoms meet the criteria for clinical diagnosis of major neurocognitive disorder with Lewy bodies (MNDLB) is the continuous cognitive decline that causes interference with the activities of daily living, social or occupational functions (Donaghy & McKeith, 2014). Memory impairment is also an indication of the progression of cognitive decline. In addition, patients manifest deficits in attention and executive function. Other clinical features in MNDLB include inconsistent cognition, intermittent visual hallucinations, rest tremor, as well as REM sleep behavior disorder (McKeith et al, 2017). Mr. Wingate manifests memory impairment and progressive cognitive decline that are interfering with social functions and activities of daily living. For example, he got lost while driving, makes errors like when paying monthly bills, left door unclosed, and forgot food in the oven while cooking. He also has REM sleep behavior disorder as indicated by Mr. Wingate screaming during nightmares and kicking while sleeping. Finally, MSE reveals an impairment of insight, concentration, and attention. By selecting this decision, it was hoped that the correct diagnosis would be made in order to facilitate appropriate treatment for the patient.

Decision #2: Treatment Plan for Psychotherapy

The selected decision point two is to start Rivastigmine 1.5 mg orally twice a day. The rationale for selecting this decision is that Rivastigmine is the cholinesterase inhibitor that has the widest evidence support regarding its efficacy in improvement of cognitive function, global function, as well as activities of daily living (Jellinger & Amos, 2018). Even if Mr. Wingate does not improve on taking Rivastigmine, he is not likely to deteriorate. This is line with McKeith et al (2017) who provide that Rivastigmine has beneficial effects for cognitive and psychiatric symptoms in MNDLB. Neurocognitive Disorders Sample Research

With this decision, it was hoped that there would be some notable symptom improvement for Mr. Wingate and that even if there would be no improvement, his condition would stop getting worse. This is because Rivastigmine is a cholinesterase inhibitor that slows disease progression and hence Mr. Charles’ condition is not expected to deteriorate (Jellinger & Amos, 2018). It was also hoped that the patient would experience minimal side effects because Rivastigmine contains a transdermal preparation and therefore has few side effects.

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The results of the decision were that Mr. Wingate’s symptoms did not deteriorate and there was no improvement either. This was just as it was expected because Rivastigmine only slows the disease progress but does not have significant improvement on the existing cognitive deficits (Jellinger & Amos, 2018). Additionally, just as expected, the patient was tolerating the medication well. However, it was reported the Mr. Charles’ nightmares were worsening and he was “acting out” more during his nightmares. The reason for this is because individuals with MNDLB. Have disordered sleep and have a high likelihood of experiencing the vivid dreams that are normally aggravated by cholinesterase inhibitors (Boot, 2015). Therefore, the worsening of Mr. Charles’ nightmares is attributable to the side effects of Rivastigmine medication.

Decision #3: Treatment Plan for Psychopharmacology

The selected decision point three is to start Clonazepam 0.5 mg orally at bedtime. The rationale for selecting this decision is to treat REM sleep behavior disorder that seems to be worsening with the intake of Rivastigmine. Evidence suggests clonazepam to reduce the frequency of sleep-allied injuries that occur as a result of REM sleep behavior disorder (Hogi & Stefani, 2017). Aurora et al (2015) also provide that clonazepam is highly effective in treating REM sleep behavior disorder and relieves symptoms in the majority of individuals with REM sleep behavior disorder.

With this decision, it was hoped that Mr. Charles’ nightmares would reduce and that symptoms of REM sleep behavior disorder would also improve.

Ethical Considerations

Treatment of clients with cognitive impairment such as Mr. Wingate involves ethical issues such as informed consent, autonomy, decision-making capacity, and other measures to ensure their rights (Dunn et al, 2015). For example, Mr. Charles’ ability to understand and the reason is impaired and this may erode his ability to make any decision regarding his treatment. It would necessary to ensure Mark the son is involved in his entire treatment plan since caregivers and family can participate in decision-making if the patient lacks the ability to do so (Dunn et al, 2015). Neurocognitive Disorders Sample Research

Conclusion

The first decision is that Mr. Wingate’s diagnosis is major neurocognitive disorder with Lewy bodies because he manifests symptoms consistent with DSM-5 criteria of MNDLB. The second selected decision is to start Rivastigmine 1.5 mg orally twice a day for the client because this medication is a cholinesterase inhibitor that has been shown to be effective in the treatment of MNDLB. The final decision is to start clonazepam 0.5 mg orally at bedtime in order to treat the client’s deteriorating REM sleep behavior disorder. Finally, since the client has cognitive impairment, ethical aspects such as autonomy, decision-making capacity and informed consent will impact the treatment plan.

References

Aurora R, Zak R, Maganti R,; Auerbach S, Casey K, Chowdhuri S, Karippot A, Ramar K, Kristo D & Morgenthaler T. (2015). Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med. 6(1):85-95.

Boot B. (2015). Comprehensive treatment of dementia with Lewy bodies. Alzheimer’s Research & Therapy.7(45).

Donaghy P & McKeith I. (2014). The clinical characteristics of dementia with Lewy bodies and a consideration of prodromal diagnosis. Alzheimers Res Ther. 6(4): 46.

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

Hogi B & Stefani A. (2017). REM sleep behavior disorder (RBD). Somnologie (Berl). 21(1): 1–8.

Jellinger K & Amos K. (2018). Are dementia with Lewy bodies and Parkinson’s disease dementia the same disease? BMC Med. 16(34).

McKeith I, Boeve B et al. (2017). Diagnosis and management of dementia with Lewy bodies. Neurology. 89(1): 88–100.

Neurocognitive Disorders Sample Research

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