WEEK 11 - Basic Psychopharmacology for Counselors and Psychotherapists - Chapter 10 CHAPTER TEN: TREATMENT OF COGNITIVE DISORDERS Instructor: Jeff Garrett Ph.D.
Objective: To learn the various forms and causes of dementia, and how best to treat them and reduce the negative aspects caused by these conditions. The advantages and disadvantages of various medications for cognitive decline will be explored.
Topics to be addressed:- Forms of dementia.- Alzheimer's disease.- Medications for cognitive disorders.- Other approaches to cognitive enhancement.- Other significant issues to consider.
Cognitive Disorders Consist of Delirium and Dementia Delirium- Delirium is an acute confusional state that is basically a medical emergency; the patient needs acute medical treatment to find the etiology of the confusion and treat it accordingly.- For the most part, delirium would not be part of a patient's clinical presentation to your treatment settings. Dementia- On the other hand, dementia is becoming more of an issue as our population ages.- Alzheimer's disease (AD), the most common type of dementia, affects more than 15 million people worldwide; the United States has about 4 million people with the disease.- Estimates indicate that the prevalence of AD in the United States will rise to approximately 9.3 million over the next fifty years.- This would translate to about 1 in 45 Americans with AD.
FORMS OF DEMENTIAMemory disturbance as their central feature. The three most common forms are: 1. Alzheimer's disease.2. Dementia with Lewy bodies.3. Vascular dementia.
MEDICATIONS FOR COGNITIVE DISORDERS - Only a few approved medications are available for treatment of Alzheimer's disease.- These drugs improve cognitive function only modestly; however, they are best conceptualized as drugs that "stabilize" cognition, activities of daily living, and behavioral function.- Basically, the cholinesterase inhibitors slow the clinical deterioration in AD, but they do not cure it.
OTHER APPROACHES TO COGNITIVE ENHANCEMENT. - Vitamin E and other antioxidants have been used to slow the progression of aging and dementia.- Another medication to consider is selegiline (Eldepryl), which is a selective inhibitor of monoamine oxidase.- Estrogen replacement therapy - Studies in postmenopausal women suggest that estrogen replacement therapy decreases the risk of AD for this population.- Nonsteroidal anti-inflammatory drugs (NSAIDS) - Research suggests that NSAIDS might decrease the risk of AD in some patients. At this point in time, the use of NSAIDS and aspirin does not seem promising in the treatment of AD; however, they may be helpful in prevention.- Lipid-lowering agents - Agents that lower cholesterol may be useful in preventing AD. Atorvastatin (Lipitor), simvastatin (Zocor), and pravastatin (Pravachol) are common examples of statins. Clinical trials are currently underway to evaluate their usefulness in the treatment of AD.
OTHER SIGNIFICANT ISSUES TO CONSIDER. - Behavioral complications of dementia include physical agitation, verbal aggression, physical aggression, depression, and psychosis.- If an AD patient primarily has depressive and anxiety symptoms, an SSRI would be an excellent choice.- Except for Alzheimer's disease the, data is sparse on the treatment of other dementia syndromes.