Please provide a response to this. a. Propose an alternative on-label b.

Please provide a response to this.
a. Propose an alternative on-label
b. Propose an alternative off-label pharmacological treatment
c. Propose an alternative nonpharmacological treatment for the disorders
d. Justify your suggestions with at least two references to the literature
Dementia in Elderly
In the Diagnostic and Statistical Manual of Mental Disorders, dementia is classified as a Neurocognitive Disorder (NCD). NCDs are further categorized into Minor NCDs and Major NCDs. The word “cognitive” refers to thinking and associated activities, but the phrase “neurocognitive” refers to similar illnesses in order to emphasize that brain disease and impaired brain function result in NCD symptoms. Dementia is defined by persistent memory impairment, particularly in recent memory, severe enough to impair the patient’s ability to engage in professional and social activities (Hamdy et. al, 2022). The Food and Drug Administration (FDA) of the United States authorized the first generic versions of Aricept. Donepezil hydrochloride is intended for the treatment of Alzheimer’s disease-related dementia (PsychRx, 2009). Tablets that dissolve on the tongue do not need to be eaten completely. This may make it simpler for elderly who have difficulties swallowing to take the drug. Antipsychotic medications are administered ‘off-label’ for dementia patients. This implies that practitioners may prescribe them if they have a valid cause and follow the General Medical Council’s guidelines. Seroquel is an antipsychotic drug that is prescribed off label for dementia patients. Antipsychotic medications may have a modest but considerable positive impact on agitation, violence, and, to a lesser degree, psychosis in individuals with dementia. Typically, improvements are seen only after many weeks of treatment with these medications. The findings indicate that quetiapine is beneficial in alleviating behavioral symptoms, delirium and hallucinations, aggression, and sleep difficulties (Onor et. al, 2007). Tolerability of quetiapine was found to be excellent. The sole clinically significant adverse event was orthostatic hypotension, which was somewhat avoidable with a slower medication titration. Aromatherapy is one of the newest supplementary treatments (Ball et. al, 2020). It seems to offer a number of benefits over the extensively utilized pharmaceutical therapies for dementia. It projects a favorable image and facilitates contact by giving a sensory experience. Additionally, it seems to be well tolerated when compared to neuroleptic or sedative medications. Lavender and melissa balm are the two primary essential oils used in aromatherapy for dementia. Additionally, they provide a variety of administration methods, including inhalation, bathing, massage, and topical treatment in the form of a cream. This implies that the treatment may be tailored to people with varying behaviors: inhalation, for example, may be more useful than massage for a person experiencing restlessness. Recent controlled studies have shown considerable decreases in agitation, as well as great compliance and tolerability (Beck et. al, 2021).
Donepezil may cause nausea, vomiting, diarrhea, urinary leakage (incontinence), vivid nightmares, reduced heart rate, tiredness, and weakness in certain people. These may be dangerous for people who are already malnourished, have cardiovascular issues, or are at risk of falling (Pelton et. al, 2014). Cerebrovascular risk factors such as hypertension, ischemia and other cardiovascular disease, diabetes mellitus, smoking, family history of heart disease and stroke, transient ischemic attacks (TIAs), and hyperlipidemia should be evaluated. Alcohol/substance abuse, traumatic brain damage, thyroid illness, and other medical disorders, as well as surgery and hospitalization, should all be evaluated. Seroquel also has an increased risk of cerebrovascular events.
Currently existing pharmacological therapies for dementia are mostly symptomatic in nature and have little efficacy (Shaji et. al, 2018). It would be best to design pharmacological therapy for dementia after a thorough examination to ascertain the potential subtype, related behavioral and psychiatric symptoms, and comorbidity, among other factors. The treatment of dementia should be directed on enhancing cognitive performance, alleviating associated behavioral and psychological symptoms, and enhancing or stabilizing global functioning in everyday activities. All individuals with dementia need behavioral and psychological therapies. Pharmacological therapy, especially for behavioral and psychological symptoms of dementia, should be considered in addition to this.

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