Alzheimer’s and Dementia Cognitive Preservation

Psych360’s Cognitive Preservation Program focuses on Dementia and Alzheimer’s diseases. The goal of this program is for early mental health intervention as it relates specifically to these diseases. Many times, the tendency is to wait or delay mental health provider care for a variety of reasons. 

However, earlier appropriate and reasonable clinical mental health medical care can be offered to the patient is a better practice. In addition, earlier treatment means a proactive approach can be administered, rather than a reactive response to the symptoms of the disease process. This is critical in minimizing the symptoms and slowing the memory loss associated with the disease process. 

The fewer disruptions to routine and quality of life, the more manageable the disease process.

Medication for Dementia and Alzheimer’s

There are mainly two types of medication therapies for this disease:

  1. Cognitive enhancer medications, which may slow down the disease progression.
  2. Symptomatic therapies, available but do not act on the evolution of the disease.

Secondary Symptoms of Dementia

Secondary symptoms of most types of dementia include depression, anxiety, agitation, aggression, hallucinations, delusions, paranoia, insomnia, and other sleep disorders. These can be problematic, and the more severe these symptoms, the greater the impact on the patient’s condition. Behavioral symptoms, in particular, are common and can exacerbate cognitive and functional impairment and influence a more rapid decline of the disease. They can be found across most varieties of dementia, such as frontotemporal dementia, vascular dementia, and of course Alzheimer’s disease

Specific Medications Used to Treat Secondary Conditions

The following psychotropic medications have been used to clinically treat these secondary symptoms. Psychotropic medications can include antidepressants, antipsychotics, and anti-anxiety medications, as well as mood-stabilizers and hypnotic medications. These drugs may be prescribed, at times, to treat some of the behavioral and emotional symptoms of dementia and Alzheimer’s disease. This class of medications is typically used after attempting non-pharmacologic interventions consistently and finding them to be ineffective.

While these medications can be productive at times, minimizing the addition of medications is important in reducing polypharmacy. If successful, this can result in improved cognition, quality of life, and overall general health. 

The Goal of Cognitive Preservation

It is the goal of this clinical program to implement a coordinated medical effort in order to preserve the mental health and cognitive function of the patients leading to enhanced quality of daily life and memory preservation for as long as possible during the disease process.

More about CMS Psychotropic Rules and Regulations

Psychotropic Drug

What is a psychotropic drug?

Any drug that affects brain activities associated with mental processes and behavior.

These drugs include, but are not limited to, drugs in the following categories:

  • Antipsychotic
  • Antidepressant
  • Anti-anxiety
  • Hypnotic

What are the psychotropic drugs guidelines?

These medications receive gradual dose reductions (GDR), and behavioral interventions, unless clinically contraindicated, in an effort to discontinue these drugs.

Within the first year in which a resident is admitted on a psychotropic medication or after the prescribing practitioner has initiated a psychotropic medication:

  • The facility must attempt a GDR in two separate quarters (with at least one month between the attempts), unless clinically contraindicated.
  • After the first year, a GDR must be attempted annually, unless clinically contraindicated.
  • However, some residents with specific, enduring, progressive, or terminal conditions may need specific types of psychotropic medications or other medications which affect brain activity indefinitely. i.e. chronic depression, Parkinson’s disease,, psychosis, or recurrent seizures.

For any individual who is receiving a psychotropic medication to treat expressions or indications of distress related to dementia, GDR may be considered clinically contraindicated for reasons that include, but that are not limited to:

  • The resident’s target symptoms returns or worsens after the most recent attempt at a GDR within the facility; and
  • The prescribing practitioner has documented the clinical rationale for why any additional attempted dose reduction at that time would likely impair the resident’s function or increase distressed behavior.

Diagnoses alone do not necessarily warrant the use of an antipsychotic medication.

Appropriate indications for antipsychotics:

  • Schizophrenia (will not trigger on MDS)
  • Bipolar Mania
  • Huntington’s disease (will not trigger on MDS)
  • Tourette’s syndrome (will not trigger on MDS)
  • Delusional disorder
  • Depression with psychotic features
  • Psychosis NOS (in the absence of dementia)

Antipsychotic medications may be indicated if:

  • Behavioral symptoms present a danger to the resident or others.
  • Expressions or indications of distress that cause significant distress to the resident.
  • If not clinically contraindicated, multiple non-pharmacological approaches have been attempted, but did not relieve the symptoms which are presenting a danger or significant distress.
  • GDR was attempted, but clinical symptoms returned.

If antipsychotic medications are prescribed, documentation must clearly show the indication for the antipsychotic medication, the multiple attempts to implement care-planned, non-pharmacological approaches, and ongoing evaluation of the effectiveness of these interventions.

What is the PRN Rule?

Residents do not receive psychotropic drugs pursuant to a PRN order unless that medication is necessary to treat a diagnosed specific condition that is documented in the clinical record.

PRN orders for psychotropic drugs (except antipsychotics) are limited to 14 days, except if the prescribing practitioner believes that it is appropriate for the PRN order to be extended beyond 14 days. In this case, he or she should document their rationale in the resident’s medical record and indicate the duration for the PRN order.

PRN orders for antipsychotic drugs, which are limited to 14 days, cannot be renewed unless the attending physician or prescribing practitioner evaluates the resident (in person) for the appropriateness of that medication.

Psych360 Evaluation Guidance:

  • Is the antipsychotic medication still needed on a PRN basis?
  • What is the benefit of the medication to the resident?
  • Have the resident’s expressions or indications of distress improved as a result of the PRN medication?

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