PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED BELOW 1). ZERO (0) PLAGIARISM 2). ATLEAST 5 REFERENCES, NO MORE THAN 5 YEARS 3).  PLEASE SEE  ATTACHED RUBRIC DETAILS AND RECOMMENDED COURSE WRITING TEMPLATE AND APA 7 STYLE 4). Please review and follow the grading rubric details, and include each component in the assignment as required. Also, follow the APA writing rules and style, Title page, summary, Purpose statement, Conclusion.  For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.  To Prepare Review the interactive media piece assigned.  Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece. Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned. You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment. Write a 1- to 2-page summary paper that addresses the following: Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources. What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources. Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples. Alzheimer’s Disease 76-year-old Iranian Male BACKGROUND Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal. According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.” Over the c.

1. PLEASE FOLLOW THE INSTRUCTIONS AS INDICATED
BELOW
1). ZERO (0) PLAGIARISM
2). ATLEAST 5 REFERENCES, NO MORE THAN 5 YEARS
3). PLEASE SEE ATTACHED RUBRIC DETAILS AND
RECOMMENDED COURSE WRITING TEMPLATE AND APA
7 STYLE
4). Please review and follow the grading rubric details, and
include each component in the assignment as required. Also,
follow the APA writing rules and style, Title page, summary,
Purpose statement, Conclusion.
For your Assignment, your Instructor will assign you one of the
decision tree interactive media pieces provided in the
Resources. As you examine the patient case studies in this
module’s Resources, consider how you might assess and treat
patients presenting symptoms of neurological and
musculoskeletal disorders.
To Prepare
Review the interactive media piece assigned.
Reflect on the patient’s symptoms and aspects of the disorder
presented in the interactive media piece.
Consider how you might assess and treat patients presenting
with the symptoms of the patient case study you were assigned.

2. You will be asked to make three decisions concerning the
diagnosis and treatment for this patient. Reflect on potential co-
morbid physical as well as patient factors that might impact the
patient’s diagnosis and treatment.
Write a 1- to 2-page summary paper that addresses the
following:
Briefly summarize the patient case study you were assigned,
including each of the three decisions you took for the patient
presented.
Based on the decisions you recommended for the patient case
study, explain whether you believe the decisions provided were
supported by the evidence-based literature. Be specific and
provide examples. Be sure to support your response with
evidence and references from outside resources.
What were you hoping to achieve with the decisions you
recommended for the patient case study you were assigned?
Support your response with evidence and references from
outside resources.
Explain any difference between what you expected to achieve
with each of the decisions and the results of the decision in the
exercise. Describe whether they were different. Be specific and
provide examples.
Alzheimer’s Disease

3. 76-year-old Iranian Male
BACKGROUND
Mr. Akkad is a 76 year old Iranian male who is brought to your
office by his eldest son for “strange behavior.” Mr. Akkad was
seen by his family physician who ruled out any organic basis for
Mr. Akkad’s behavior. All laboratory and diagnostic imaging
tests (including CT-scan of the head) were normal.
According to his son, he has been demonstrating some strange
thoughts and behaviors for the past two years, but things seem
to be getting worse. Per the client’s son, the family noticed that
Mr. Akkad’s personality began to change a few years ago. He
began to lose interest in religious activities with the family and
became more “critical” of everyone. They also noticed that
things he used to take seriously had become a source of
“amusement” and “ridicule.”
Over the course of the past two years, the family has noticed
that Mr. Akkad has been forgetting things. His son also reports
that sometimes he has difficult “finding the right words” in a
conversation and then will shift to an entirely different line of
conversation.
SUBJECTIVE
During the clinical interview, Mr. Akkad is pleasant,
cooperative and seems to enjoy speaking with you. You notice
some confabulation during various aspects of memory testing,
so you perform a Mini-Mental State Exam. Mr. Akkad scores 18
out of 30 with primary deficits in orientation, registration,
attention & calculation, and recall. The score suggests moderate
dementia.

4. MENTAL STATUS EXAM
Mr. Akkad is 76 year old Iranian male who is cooperative with
today’s clinical interview. His eye contact is poor. Speech is
clear, coherent, but tangential at times. He makes no unusual
motor movements and demonstrates no tic. Self-reported mood
is euthymic. Affect however is restricted. He denies visual or
auditory hallucinations. No delusional or paranoid thought
processes noted. He is alert and oriented to person, partially
oriented to place, but is disoriented to time and event [he
reports that he thought he was coming to lunch but “wound up
here”- referring to your office, at which point he begins to
laugh]. Insight and judgment are impaired. Impulse control is
also impaired as evidenced by Mr. Akkad’s standing up during
the clinical interview and walking towards the door. When you
asked where he was going, he stated that he did not know. Mr.
Akkad denies suicidal or homicidal ideation.
Diagnosis: Major neurocognitive disorder due to Alzheimer’s
disease (presumptive)
RESOURCES
§ Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002).
Mini-Mental State Examination (MMSE). Lutz, FL:
Psychological Assessment Resources.
Decision Point One
Select what you should do:
Decision Point One

5. Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase
to 3 mg orally BID in 2 weeks
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
The client is accompanied by his son who reports that his father
is “no better” from this medication. He reports that his father is
still disinterested in attending religious services/activities, and
continues to exhibit disinhibited behaviors
You continue to note confabulation and decide to administer the
MMSE again. Mr. Akkad again scores 18 out of 30 with primary
deficits in orientation, registration, attention & calculation, and
recall
Decision Point One
: Begin Aricept (donepezil) 5 mg orally at BEDTIME
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
The client is accompanied by his son who reports that his father
is “no better” from this medication
He reports that his father is still disinterested in attending
religious services/activities, and continues to exhibit
disinhibited behaviors

6. You continue to note confabulation and decide to administer the
MMSE again. Mr. Akkad again scores 18 out of 30 with primary
deficits in orientation, registration, attention & calculation, and
recall
Decision Point One
Begin Razadyne (galantamine) 4 mg orally BID
RESULTS OF DECISION POINT ONE
Client returns to clinic in four weeks
The client is accompanied by his son who reports that his father
is “no better” from this medication
He reports that his father is still disinterested in attending
religious services/activities, and continues to exhibit
disinhibited behaviors
You continue to note confabulation and decide to administer the
MMSE again. Mr. Akkad again scores 18 out of 30 with primary
deficits in orientation, registration, attention & calculation, and
recall
Decision Point Two
Select what you should do next:

7. Decision Point Two
Increase Razadyne to 24 mg extended release daily
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
The client’s son accompanies the client to his appointment
today. The client is in a wheelchair and is somewhat agitated
You are informed by the son that his father has not taken his
medication since he got out of the hospital. Apparently, about 7
days after starting the Galantamine extended release, the client
began having seizures which resulted in a fall and fractured hip.
The son reports that his father is agitated with everyone and is
asking for help in treating his agitation
Decision Point Two
Discontinue Razadyne and begin Aricept (donepezil) 10 mg
orally daily
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
The client is accompanied by his son for today’s appointment

8. who informs you that he stopped giving his father the mew
medication because after just a few doses, his father began
experiencing appetite loss, followed by nausea, diarrhea, and
vomiting
Decision Point Two
Discontinue Razadyne and begin Exelon (rivastigmine) 1.5 mg
orally BID
RESULTS OF DECISION POINT TWO
Client returns to clinic in four weeks
Client’s son reports that the client is tolerating the medication
well, but is still concerned that his father is no better
He states that his father is still not interested in attending
religious services with the family, and he is still concerned that
his father is still easily amused by things he once found serious
Decision Point Three
Select what you should do next:
Decision Point Three

9. Increase Exelon to 3 mg orally BID
Guidance to Student
Cholinesterase inhibitors can take months to demonstrate any
stabilization in the degenerative course of Alzheimer’s disease.
Since the client has had no side effects, it would be prudent to
consider increasing the Exelon dose to 3 mg orally BID. Recall
that the target dose of Exelon is 12 mg orally daily in divided
doses, or a transdermal patch delivering 9.5 mg daily could be
used. Slow titration of the drug toward a therapeutic dose will
decrease the risk of side effects. These should be teaching
points directed toward the client and his son.
You could maintain the current dose of Exelon and reevaluate at
the next office visit, but since the client is having no side
effects and the client has been on the current dose for at least 4
weeks, it would probably be advisable to increase at this time to
facilitate the goal of arriving at a therapeutic dose of the
medication.
It may be early to augment with Namenda. Maximization of the
Exelon dose should first occur, then augmentation with an
NMDA receptor antagonist would be appropriate, but Namenda
should be started at 5 mg orally daily, and then titrated up to a
maximum dose of 10 mg orally BID. Doses over 5 mg orally
daily should be divided into two doses, or the drug can be
switch to an extended release preparation.
Finally, it is important to note that changes in the MMSE should
be evaluated over the course of months, not weeks. The absence
of change in the MMSE after 4 weeks of treatment should not be
a source of concern.
Decision Point Three

10. Continue current dose of Exelon and reevaluate at next office
visit
Guidance to Student
Cholinesterase inhibitors can take months to demonstrate any
stabilization in the degenerative course of Alzheimer’s disease.
Since the client has had no side effects, it would be prudent to
consider increasing the Exelon dose to 3 mg orally BID. Recall
that the target dose of Exelon is 12 mg orally daily in divided
doses, or a transdermal patch delivering 9.5 mg daily could be
used. Slow titration of the drug toward a therapeutic dose will
decrease the risk of side effects. These should be teaching
points directed toward the client and his son.
You could maintain the current dose of Exelon and reevaluate at
the next office visit, but since the client is having no side
effects and the client has been on the current dose for at least 4
weeks, it would probably be advisable to increase at this time to
facilitate the goal of arriving at a therapeutic dose of the
medication.
It may be early to augment with Namenda. Maximization of the
Exelon dose should first occur, then augmentation with an
NMDA receptor antagonist would be appropriate, but Namenda
should be started at 5 mg orally daily, and then titrated up to a
maximum dose of 10 mg orally BID. Doses over 5 mg orally
daily should be divided into two doses, or the drug can be
switch to an extended release preparation.
Finally, it is important to note that changes in the MMSE should
be evaluated over the course of months, not weeks. The absence
of change in the MMSE after 4 weeks of treatment should not be
a source of concern.

11. Decision Point Three
Augment with Namenda 10 mg orally at BEDTIME
Guidance to Student
Cholinesterase inhibitors can take months to demonstrate any
stabilization in the degenerative course of Alzheimer’s disease.
Since the client has had no side effects, it would be prudent to
consider increasing the Exelon dose to 3 mg orally BID. Recall
that the target dose of Exelon is 12 mg orally daily in divided
doses, or a transdermal patch delivering 9.5 mg daily could be
used. Slow titration of the drug toward a therapeutic dose will
decrease the risk of side effects. These should be teaching
points directed toward the client and his son.
You could maintain the current dose of Exelon and reevaluate at
the next office visit, but since the client is having no side
effects and the client has been on the current dose for at least 4
weeks, it would probably be advisable to increase at this time to
facilitate the goal of arriving at a therapeutic dose of the
medication.
It may be early to augment with Namenda. Maximization of the
Exelon dose should first occur, then augmentation with an
NMDA receptor antagonist would be appropriate, but Namenda
should be started at 5 mg orally daily, and then titrated up to a
maximum dose of 10 mg orally BID. Doses over 5 mg orally
daily should be divided into two doses, or the drug can be
switch to an extended release preparation.
Finally, it is important to note that changes in the MMSE should
be evaluated over the course of months, not weeks. The absence

12. of change in the MMSE after 4 weeks of treatment should not be
a source of concern.