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Introduction
Dementia is a serious condition that affects the brain. It is the umbrella term for the deterioration of cognitive and communicative functions, memory, perception, etc. It describes more than ten symptoms of such a decline in brain effectiveness. The most common type of dementia is Alzheimer’s disease. It corresponds to 60 to 80% of dementia cases (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). The prevalence of the disease is yet relatively low but is projected to grow, at least in the United States. As the population grows proportionately older each year.
The disease onset usually occurs after 66 years and is rather sporadic than familial. Risk factors for the development of the disease include senior age, family genetic impairments in the Apolipoprotein E. In addition, low education, and head injuries, as well as female sex, can also increase the risk of dementia. The diagnostic criteria for the disease include but are not limited to poor reasoning, judgment, memory loss, language difficulties, attention, and perception problems. According to American Psychiatric Association (2013), the diagnosis can only be confirmed through the autopsy.
Pharmacotherapeutic Interventions
Initiation of pharmacological therapy requires a high degree of certainty that a patient suffers from dementia or Alzheimer’s. Therefore, Clock Drawing Test and Mini-Mental State Examination together with the Functional Activities Questionnaire need to guide the decision process for medication. The individual set of symptoms usually is the basis for the prescription of drug therapy. The treatment is usually commenced at moderate or severe stages of the disease. Against potentially reversible symptoms Arcangelo et al. (2017) list a variety of drugs including benztropine, imipramine, lorazepam, and cimetidine. Corticosteroids or metoclopramide could also be valid options.
Cholinesterase inhibitors such as tacrine, donepezil, or rivastigmine are aimed at decreasing the speed of deteriorative processes of cognitive and behavioral functions in patients suffering from dementia. Rivastigmine is also approved for use in the treatment of mild cases of dementia or Alzheimer’s disease. According to Anand and Singh, (2013), that drug type provides active and effective treatment, yet does not show signs of forwarding remission. The adverse effects of the listed medications depend on the dose and administration. Nausea, vomiting, or diarrhea are among the most common side effects. In addition, certain drugs could adversely affect the gastrointestinal tract.
The Impact of Genetic Factors on the Effects of Prescribed Drugs
The recent research revealed that a low dose of pioglitazone could potentially, work in conjunction with protein Tom40 encoded by a gene called TOMM40. The latter is connected to Apolipoprotein E and is believed to have an impact on the development of dementia (Meloche, Compton, Rosario, & Brown, 2016). Therefore, the active study of genetic factors could also boost the effectiveness of drug therapy. It will also provide more options for therapists to manage the disease.
Measures to Reduce Negative Side Effects
Since many adverse effects are dose-dependent, then to avoid or minimize the adverse effect of drug therapy the dose should be increased gradually. In addition, if the effect is not visible within three to six months, another pharmacotherapeutic intervention needs to be planned. A multidisciplinary approach could also be beneficial, as it could help the therapist to tailor medication in accordance with needs and symptoms more carefully, which will allow avoiding unnecessary and unpredicted side-effects.
Conclusion
Dementia is a condition that affects the population above 65 years old. Its main symptoms are systemic cognitive, and behavioral functions deterioration. The pharmacological treatment usually includes the use of cholinesterase inhibitors that are deemed effective. Further study of genetics could narrow and make more effective the use of medications to treat this condition.
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). New York, NY: American Psychiatric Publishing.
Anand, P., & Singh, B. (2013). A review on cholinesterase inhibitors for Alzheimer’s disease. Archives of Pharmacal Research, 36(4), 375-399.
Meloche, T. M., Compton, B., Rosario, B. H., & Brown, T. L. (2016). Alzheimer’s disease pharmacotherapy, biomarkers and genetics. Journal of Neurology & Stroke, 4(2), 00127.
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