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“Just about everyone has minor memory glitches as they get older. If someone forgets a name or why he walked into the kitchen, that doesn’t mean he has Alzheimer’s” (Lava, 2017). Though the real cause behind Alzheimer’s is still a mystery, there are many theories that exist about the disease. Many of these theories are closely linked and not yet to be found accurate. Even though they don’t know what causes it for sure, there are many therapeutic medications that will help with the signs and symptoms of Alzheimer’s disease. One of the more known ways of treating the disease is with the use of donepezil (Aricept). It’s the sole medication which will treat Alzheimer’s throughout any stage. Donepezil may treat Alzheimer’s, but this disease is a “chronic and progressive neurodegenerative disease that there is no known cure for” (McCuiston, Vuljoin-Dimaggio, Winton, & Yeager, 2018, 263).
Pathophysiology & signs and symptoms of alzheimer’s
Alzheimer’s Disease is a chronic and progressive neurodegenerative disease that there is no known cure for. Although, there are many theories about the cause of Alzheimer’s disease. These theories say that Alzheimer’s is caused by the “degeneration of cholinergic neurons, neurofibrillary tangles with twists inside the neuron, deficiency of acetylcholine ACh) between cholinergic neurons, and neuritic (amyloid) plaques that are deteriorating neuronal material” (McCuiston et al. 2018, 263). According to Khan Academy, ACh helps our neurons communicate and neuritic plaques are said to disrupt communication between neurons and are said to trigger the immune response to find and destroy the disabled cells. Not only do parts of your brain start to die and be destroyed, but your brain decreases in size from the death and loss of neurons and tissue.
Alzheimer’s is a form of Dementia that is mainly defined by “trouble planning and handling day-to-day tasks, like paying bills, managing a checkbook, or using familiar appliances around the house” (Lava, 2017). Unlike other types of dementia, Alzheimer’s has three stages which are called mild, moderate, and severe. Referencing back to the Pathophysiology of alzheimer’s, the decrease in ACh, buildup of neuritic plaque, and loss of cholinergic neurons is what causes the worsening of symptoms. As the stages progress, an individual will start to become more dependent on a caregiver.
Mild is the first stage and at this stage individuals are still able to do their regular ADL’s. According to McCuiston et al., they will start to have memory lapses, difficulty concentrating, misplace objects, forget what they just read, and has increased problems with planning and organization. Moderate is the next stage, which is also the longest stage. During this stage the individual may display frustration at self and others around them, have changes in their sleeping pattern, unable to recall personal information, may wander around and get lost, they will need help caring for themselves, and some may start to have difficulty controlling bladder and bowels. As an individual progress’s into the severe stage they may have trouble talking and recognizing loved ones, they may also have “trouble eating and walking which makes them more susceptible to infections like pneumonia” (McCuiston et al. 2018, 263). These are the well-known stages of Alzheimer’s, and they are one of the hardest things any human should have to watch a loved one go through. It’s like watching a loved one die twice. Once from the deterioration of their mind, and the second when they pass on.
donepezil (Aricept)
The cure for Alzheimer’s Disease has still yet to be found, but there are four medications that can help treat the disease. They are donepezil, rivastigmine, memantine, and galantamine. Donepezil is the only drug that can be used throughout all the stages unlike the other drugs. Donepezil also known by its trade name Aricept, and it is an Acetylcholinesterase (AChE) Inhibitor. “AChE is an enzyme responsible for breaking down ACh” (McCuiston et al. 2018, 263). Referencing back to the Pathophysiology of alzheimer’s, people with Alzheimer’s already have a deficiency in ACh, so by taking donepezil (Aricept) it binds with AChE, thus, inhibiting it from binding and breaking down ACh which makes more ACh available to connect with receptors of the receiving neuron.
Donepezil is indicated for “mild, moderate, or severe dementia /neurocognitive disorder associated with Alzheimer’s disease” (Vallerand, Sanoski, & Deglin, 2017, 454). This drug can be used to help with memory and alertness in other dementia’s. It is not a cure, but a treatment. The desired outcome is enhanced cognition, memory, and the ability to perform some ADL’s (Vallerand at el. 2017, 454). It is available in tablets, orally disintegrating tablets, and in combination with memantine (Namzaric). Tablets and oral disintegrating tablets come in doses of 5mg, 10mg, and 23mg, but they say to start with 5mg once daily and after 4-6 weeks they can increase to 10mg daily, and for severe Alzheimer’s 23mg after 3 months (Vallerand at el. 2017, 454).
Donepezil also has a half-life of 70 hours, which is about 6 days, due to increased protein binding. So, it is important to know what the side effects and adverse effects are. Some of the more common side effects are headache, dizziness, diarrhea, and nausea (Vallerand at el. 2017, 454). Thankfully, there are no known life-threatening effects. But, this drug is listed under Pregnancy Category C, which means there has not been an adequate amount of research done on animals or pregnant women to determine if these drugs cause adverse effects and/or fetal abnormalities (Vallerand at el. 2017, 1412).
There is a lot to worry about, but it crucial to tell the physician of any prescription drugs, over the counter medications, and herbal remedies that an individual might be taking. Drug to drug interactions are of a higher concern because they alter the effect of the drug being given and can increase adverse effects. “Increases cholinergic effects of bethanechol” (Vallerand at el. 2017, 454). This can increase effects like nausea, vomiting, diarrhea, urination, sweating, and bradycardia. To prevent this from happening, tell your physician about anything that you are taking even if it feels miniscule. Throughout the therapy of donepezil (Aricept), the physician and nurses should be periodically monitoring an individual’s heart rate for bradycardia (Vallerand at el. 2017, 454).
In addition, more important patient teaching goes along with this drug therapy. It is important to take donepezil one a day at the same time every day. If you missed a dose, don’t double up the next dose or just take it hours later, skip the dose and just take it as it was regularly scheduled the next day (Vallerand at el. 2017, 454). It is also good to know that you won’t see desired effects within a couple days, it may take a couple weeks to see those effects. In consideration to administration, donepezil should be taken at night just before going to bed. If taking a disintegrating tablet, one should let it dissolve on tongue first before following up with a drink of water (Vallerand at el. 2017, 455). If an individual is taking a “23mg tablet, it is best not to crush, split or chew the tablet because it may increase absorption” (Vallerand at el. 2017, 455).
Conclusion
Donepezil helps an Alzheimer’s patient with their memory and alertness, but it can have some side effects like dizziness and nausea. It is always best to tell a physician if any side effects start to occur, if pregnant, and notify them of any other medications and/or herbal remedies currently being taken. Drug to drug interactions may occur and cause adverse effects or affect the effectiveness of donepezil (Aricept). Always follow physician guidelines and do not take more than you are prescribed. If you miss a dose, skip it and take it the next day at its normal time. In the end, donepezil (Aricept) is only a treatment to help cognition in Alzheimer’s patients, it can’t stop the deterioration of their mind, it’s not a cure.

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