Problem: You are evaluating a 79-year-old man who was diagnosed with dementia 6 years previously. He lives with his 72-year-old wife. He was a chain smoker for 45 years. She describes a gradual deterioration in his condition such that in recent months she has found it increasingly difficult to manage him. He has become increasingly hostile and aggressive, though he has not actually assaulted her. He has begun to complain of seeing people wandering around the house, and that frightens him. On two occasions he has left the house and been found wandering along the road. She has noticed that his condition fluctuates - sometimes he is very aggressive and confused, while at other times he is more calm and lucid.
At all times, explain your answers.
Q1. What is the DSM 5-TR diagnosis based on the information provided in the case?
Q2. Which pharmacological treatment would you prescribe? Include the rationale for this treatment.
Q3. Which non-pharmacological treatment would you prescribe? Include the rationale for this treatment excluding a psychotherapeutic modality.
Q4. Include an assessment of the treatment's appropriateness, cost, effectiveness, safety, and potential for patient adherence to the chosen medication. Use a local pharmacy to research the cost of the medication and provide the most cost-effective choice for the patient.