Assignment: Respond to at least two of your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned. Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. Colleagues Respond # 1 Criteria for Alzheimer’s Disease Alzheimer’s disease is a slowly progressing disorder where the individual may be asymptomatic for many years in preclinical phase, followed by a period called mild cognitive impairment without functional deficit, and finally leading to dementia or neurocognitive syndrome with cognitive deficits, functional decline with neuropsychiatric symptoms (Gabbard 2014).  According to American psychiatric association (2013), neurocognitive disorders can be either major or mild neurocognitive disorder. To diagnose Alzheimer’s disease, the DSM-5 has given criteria as follows.   Major neurocognitive disorder due to Alzheimer’s disease are diagnosed either as probable and possible Alzheimer’s disease (American psychiatric association 2013). Probable Alzheimer’s disease is diagnosed if either of the following are present otherwise, possible Alzheimer’s disease is diagnosed. 1.Evidence of a causative Alzheimer’s disease genetic mutation from family history or genetic testing 2. All three of the following such as a) Clear evidence of decline in memory and learning and at least one other cognitive domain based on detailed history or serial neuropsychological testing, b) Steadily progressive, gradual decline in cognition, without extended plateaus, c) No evidence of mixed etiology such as absence of other neurodegenerative or cerebrovascular disease, or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline  Mild neuro cognitive disorder due to Alzheimer’s disease can be either Probable or possible Alzheimer’s disease (American Psychiatric association 2013). Probable Alzheimer’s disease is diagnosed if there is evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history. Possible Alzheimer’s disease is diagnosed if there is no evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history, and all three of the following are present such as a) clear evidence of decline in memory and learning, b) steadily progressive, gradual decline in cognition, without extended plateaus, no evidence of mixed etiology such as absence of other condition likely contributing to cognitive decline. c) The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder. Psychopharmacological Treatment It is important to minimize or eliminate medications that impair cognition such as anticholinergics, opio.

1. Assignment:
Respond
to at least
two
of your colleagues by comparing the differential diagnostic
features of the disorder you were assigned to the diagnostic
features of the disorder your colleagues were assigned.
Support your responses with evidence-based literature with at
least two references in each colleague’s response with proper
citation in APA Format.
Colleagues
Respond # 1
Criteria for Alzheimer’s Disease
Alzheimer’s disease is a slowly progressing disorder where the
individual may be asymptomatic for many years in preclinical
phase, followed by a period called mild cognitive impairment
without functional deficit, and finally leading to dementia or
neurocognitive syndrome with cognitive deficits, functional
decline with neuropsychiatric symptoms (Gabbard 2014).
According to American psychiatric association (2013),
neurocognitive disorders can be either major or mild
neurocognitive disorder. To diagnose Alzheimer’s disease, the
DSM-5 has given criteria as follows.

2. Major neurocognitive disorder due to Alzheimer’s disease are
diagnosed either as probable and possible Alzheimer’s disease
(American psychiatric association 2013). Probable Alzheimer’s
disease is diagnosed if either of the following are present
otherwise, possible Alzheimer’s disease is diagnosed.
1.Evidence of a causative Alzheimer’s disease genetic mutation
from family history or genetic testing
2. All three of the following such as a) Clear evidence of
decline in memory and learning and at least one other cognitive
domain based on detailed history or serial neuropsychological
testing, b) Steadily progressive, gradual decline in cognition,
without extended plateaus, c) No evidence of mixed etiology
such as absence of other neurodegenerative or cerebrovascular
disease, or another neurological, mental, or systemic disease or
condition likely contributing to cognitive decline
Mild neuro cognitive disorder due to Alzheimer’s disease can be
either Probable or possible Alzheimer’s disease (American
Psychiatric association 2013).
Probable Alzheimer’s disease is diagnosed if there is evidence
of a causative Alzheimer’s disease genetic mutation from either
genetic testing or family history. Possible Alzheimer’s disease
is diagnosed if there is no evidence of a causative Alzheimer’s
disease genetic mutation from either genetic testing or family
history, and all three of the following are present such as a)
clear evidence of decline in memory and learning, b) steadily
progressive, gradual decline in cognition, without extended
plateaus, no evidence of mixed etiology such as absence of
other condition likely contributing to cognitive decline. c) The
disturbance is not better explained by cerebrovascular disease,
another neurodegenerative disease, the effects of a substance, or
another mental, neurological, or systemic disorder.

3. Psychopharmacological Treatment
It is important to minimize or eliminate medications that impair
cognition such as anticholinergics, opioid analgesics and
benzodiazepines before starting pharmacological treatment for
Alzheimer’s disease (AD) (Gabbard 2014). The general
treatment for AD are anticholinesterase inhibitors (AChEI) and
Memantine (Gabbard 2014). Acetylcholinesterase inhibitors
reversibly inhibit the activity of acetylcholinesterase, the
enzyme responsible for synaptic metabolism of acetylcholine;
their administration thereby increases levels of synaptic
acetylcholine (Gabbard 2014). The usual AChEI are Donepezil,
Galantamine, and Rivastigmine. Donepezil is an oral dissolving
tablet and once daily dosing (Gabbard 2014). It is used in mild,
moderate and severe AD and it may take up to 6 weeks to have
baseline memory improvement (Stahl 2014). The initial dose is
5 mg /day and can reach a target dose of 10 mg /day (Gabbard
2014). Galantamine is a AChEI and allosteric nicotinic receptor
modulator and is used in mild to moderate AD (Stahl 2014). The
initial dose is 4 mg /Bid for immediate release and 8 mg/day for
the extended release with a target dose of 8-12 mg Bid for
immediate release and 16-24 mg/day for extended release
(Gabbard 2014). It may take up to 6 weeks for improvement in
any baseline memory (Stahl 2014). It has reported side effects
of bradycardia. Rivastigmine is a AChEI and butyryl
cholinesterase (BuChEI) with an initial dose of 1.5 mg Bid
(Oral) or 4.6 mg/day transdermal to reach a target dose of 3-6
mg bid oral or 9.6 mg /day transdermal (Gabbard 2014). It is
used in mild to moderate AD and may take up to 6 weeks for
improvement in mild to moderate memory (Stahl 2014). The
transdermal administration decreases GI side effects (Gabbard
2014).
Another medication used to treat AD is Memantine which is a
NMDA receptor antagonist. It interferes with postulated
persistent activation of NMDA receptors by excessive glutamate

4. release in AD (Stahl 2014). The dosage is 5mg /day (initial) and
10 mg Bid (Gabbard 2014). Memory improvement is not
expected with the treatment and takes many months in for
stabilization of degenerative course (Stahl 2014). Decreased
creatinine clearance is a side effect and dose adjustment is
required if it occurs (Gabbard 2014).
Psychotherapy
A research study by Forstmeier et al. (2015) has concluded that
cognitive behavior therapy has shown benefit to both the
individual with Alzheimer’s disease having neuropsychiatric
symptoms and to the care giver where it helps reduce the use of
medication and delayed nursing home placement. insight
oriented therapy and less verbal therapies such as music therapy
and art therapy can be helpful in alleviating negative emotions
and minimizing problematic behaviors (Betty 1994)
Supportive treatment such as education, counseling about
diagnosis and prognosis, comfort, and emotional support
including instructions on safe and effective caregiving, problem
solving, and crisis intervention are important for patients and
caregivers (Gabbard 2014). It is also important to consider
safety concerns, including driving (and its eventual restriction),
living independently, medication administration, and fall risks
(Gabbard 2014). They can be helped with a safe predictable
place to live with support for activities of daily living,
assistance with managing medical comorbidities, and assistance
with advanced planning and end-of-life decisions (Gabbard
2014)
Benefits and Risks of Neurocognitive Therapies
The treatments for Alzheimer’s disease are anticholinesterase
inhibiters and memantine. These medications are not expected
to cure the disease but the beneficial part of the treatment is

5. that it helps delay the progression of neurocognitive and
physical decline. There are some side effects for Donepezil
(which is a acetylcholinesterase inhibitor ) such as
atrioventricular block, decreased appetite, diarrhea, dizziness,
headache, hypertension, nausea, syncope, torsades de pointes,
vomiting, weight loss are the major side effects (Boice, Dunay,
Epperly 2017). Galantamine has additional side effects such as
nausea, vomiting and weight loss and Rivastigmine side effects
are Abdominal pain, atrial fibrillation, atrioventricular block,
decreased appetite, diarrhea, dizziness, headache, myocardial
infarction, nausea, vomiting (Boice, Dunay, Epperly 2017). The
side effects of Memantine are confusion, constipation, diarrhea,
dizziness, vomiting; rarely, cerebrovascular event or acute
kidney injury (Boice, Dunay, Epperly 2017
Differential Diagnostic Features of Alzheimer’s Disease
Almost 80% of dementia in older people are related to
Alzheimer’s disease, however the diagnosis can be difficult
where the patients may exhibit similar pathologies and
symptoms (Alzheimer’s association n. d). Based on the major
clinical differences between major dementias, a correct
diagnosis can be made. The common dementias with similar
symptoms are Frontotemporal dementia, Levy body disease,
vascular dementia,
Creutzfeldt-Jakob Disease
and Alzheimer’s disease (Alzheimer’s association n. d).
Vascular dementia is related to cerebral vascular disease and are
seen in patients with preexisting hypertension or other
cardiovascular risk factors (Ruiz, Sadock & Sadock 2014).
Frontotemporal dementia is characterized by preponderance of
atrophy in the frontotemporal regions (Ruiz et al., 2014). In
Levy body disease the patients often have cap grass syndrome in
addition to hallucination and parkinsonian features (Ruiz et al.,
2014).

6. Colleagues
Respond # 2
Diagnosis of Dementia
Dementia is a general term used for loss of problem-solving,
language, memory, and other thinking capabilities, which are
severe and have the intensity to affect an individual's daily life.
The most common cause of dementia is Alzheimer's (Mosk et
al., 2017). It can be challenging diagnosing dementia.
Individuals with this condition have a cognitive impairment,
and they have lost the ability to attend to their daily duties such
as driving safely, paying bills, and their medications. During
the diagnosis, the doctor must recognize the oaters for the loss
of functions and skills and determine what the person can do at
that moment. Recently there has been a more accurate diagnosis
from the biomarkers of Alzheimer's disease. The doctors do
cognitive and neuropsychological tests to evaluate the patient's
thinking. Several tests involve measuring thinking skills,
language skills, judgments, reasoning, orientation, and
attention. Neurological evaluation is where the doctor will
evaluate attention, visual perception, memory, language, senses,
and movements, balance, problem-solving, and reflexes, among
other areas. Brain scans include CT or MRI, which checks the
evidence of bleeding, tumor or stroke, or hydrocephalus. PET
scans checks on the patterns of the brain. Laboratory tests
include blood samples to determine the physical problems that
can affect the brain functioning, such as deficiency of vitamin
B-12 or thyroid gland underactive.
Treatment of Dementia
Psychopharmacologic treatment includes the use of the
following: cholinesterase inhibitors, which include galantamine

7. (Razadyne), donepezil (Aricept), and rivastigmine (Exelon)
which works by boosting the levels of chemical messenger
which are involved in judgment and memory. They are used to
treat Alzheimer's disease in the primary case. Doctors might be
prescribed these drugs to other dementias, including Lewy body
dementia, Parkinson's disease dementia, and vascular dementia.
There are side effects of these drugs that include diarrhea,
vomiting, and nausea. Memantine (Namenda) regulates the
activity of glutamate, which is a chemical messenger involved
in brain functions such as memory and learning. This can also
be prescribed with a cholinesterase inhibitor and had dizziness
as one of the most common side effects. Psychotherapy includes
occupational therapy, which teaches one coping behaviors and
ensures that one is home safer. This prevents accidents and
manages behaviors as well as preparing one for the dementia
progression. Modifying the environment is another
psychotherapy that reduces noise and clutter, making it easier
for dementia to function and focus (Carrion et al., 2018). This
involves hiding objects that threaten the safety and monitoring
system, alerting when a person with dementia wanders.
Simplifying tasks will break tasks into smaller portions and
hence make one focus on success and not a failure. Routine and
structure also help to reduce confusion among people with
dementia.
Research has identified several risks involved in the treatment
of patients with dementia. Many of the patients have been
prescribed some medications which act on the nervous system
and the brain, but they are not meant to treat dementia. These
kinds of interventions have special risks for older people
(Gnjidic et al., 2018). These drugs have been linked with worse
cognitive symptoms in older adults. Depressants do not treat
dementia, but most doctors prescribe these drugs nearly triple to
the older adults. These have negative impacts and mild side
effects on the patients.