Jack RichardsKatarina MayerMakenzie Nelson

CASE #2

Case #2

A 78-year-old man comes to your office with his daughter. The daughter reports that her father, Mark, has been confusing the name of relatives and is having trouble controlling his emotions. Her father was once a respected mathematician, but he is now having trouble completing simple calculations. He even claims that he does not know how to play the card game they have been playing since she was a little girl. She tried to get him to shower and put on clean clothes for the doctor’s visit, but he is adamant about the fact that he is clean. Most recently, he has had trouble recognizing people he has known for years. For quite some time, he has had trouble finding items such as his glasses or keys and his daughter attributed this to the natural aging process. Now she is not so sure.

Patient #2

Symptoms

Confusion Instability of emotions Trouble doing math Forgetfulness/Memory Loss Stubbornness Inability to find items

Hypothyroidism Forgetfulness/

Memory loss Stubbornness Fatigue Muscle Weakness Depression

Possible Diagnoses

Dementia Confusion Instability of

emotions Forgetfulness/

Memory Loss

Stubbornness Inability to find

items

Physical Exam Asks about diet and alcohol

use Reviews all medications Check blood pressure,

temperature, and pulse Listen to the heart and lungs Perform other procedures to

assess overall health

Blood Test Test for hypothyroidism Detects the hormone levels in

the blood stream and can then the function of the thyroid can be determined

Tests for Diagnosis

Mini-Cog Tests for Alzheimer’s and dementia Patient is asked to perform two

tasks Remember and in a few minutes

repeat the names of three objects

Draw a face of a clock and draw the time instructed by the professional there

Mini-Mental State Exam (MMSE) Tests for Alzheimer’s and dementia Maximum of 30 points

20-24 points suggests mild dementia

13-20 points suggests moderate dementia

Less than 12 points suggests severe dementia

With Alzheimer’s, the points decline two to four points per year

Tests for Diagnosis

Blood test was negative for hypothyroidism Alzheimer’s shared the most symptoms with the patient Brain scans, such as a MRI and a CT scan, exhibited multiple

signs of a brain with Alzheimer’s

Actual Diagnosis- Alzheimer’s

MRI

CT

In a brain with Alzheimer's, the brain shrivels up, the hippocampus shrinks, and ventricles become larger.

Cell death and tissue loss in a brain with Alzheimer's contain plaques and dead/dying nerve cells that have tangles (twisted strands of proteins). Plaques are made up of beta-amyloid, a protein, when they clump

together. The tangles and plaques block the synapse from cell-to-cell, thus

disrupting the charges that was being transmitted. Plaques and tangles spread through the cortex.

More about Alzheimer’s

Effects of Alzheimer’s

Alzheimer’s will affect the patient’s life in the ways of Memory loss Language deterioration Impaired perception and spatial relationships Poor judgement

To make the patient feel long term ease, the thought of a home health nurse, a family member monitoring the patient, or the admittance to a nursing home may be few options the family may consider

Prognosis

Perform mental status exams that may include a 20-30 question test, asking standard questions about daily life or current events, drawing/counting items, and monitor ability to perform and complete routine activities

Other exams may test motor reactions, senses, reflexes, coordination, and the cranial nerves

Visits occur every six months or with any decline in memory or any other skills

Medical Professionals: Neurologist

Help clients in their daily personal tasks, such as bathing or dressing Provide basic health-related services according to a client’s needs, such

as checking vital signs or administering prescribed medication at scheduled times

Do light housekeeping, such as laundry, washing dishes, and vacuuming in a client’s home

Organize a client’s schedule and plan appointments Arrange transportation to doctors’ offices or for other kinds of outings Shop for groceries and prepare meals to a client’s dietary specifications Provide companionship

Medical Professional: Home Health Nurse

There are no known cures, but there are options that may help symptoms To help memory loss cholinesterase inhibitors or memantine can be

prescribed To aid behavioral abnormalities antidepressants, anxiolytics, or

antipsychotic medications could be taken

Treatment

Medical College of Wisconsin. (nd.). Alzheimer’s Disease Treatment and Prognosis. [accessed 9 October 2015]. Retrieved from: http://healthlink.mcw.edu/article/921383587.html.

Alzheimer’s Association. (nd.). Treatments for Alzheimer’s disease. [accessed 13 October 2015]. Retrieved from: http://www.alz.org/alzheimers_disease_treatments.asp

Alzheimer’s Association. (nd.). Treatments for Behavior. [accessed 13 October 2015]. Retrieved from: http://www.alz.org/alzheimers_disease_treatments_for_behavior.asp

Everyday Health. (nd.). Assembling Your Alzheimer’s Care Team. [accessed 13 October 2015]. Retrieved from: http://www.everydayhealth.com/alzheimers/alzheimers-care-team.aspx

Alzheimer’s Association. (nd.) Tests for Alzheimer’s Disease and Dementia. [accessed 13 October 2015]. Retrieved from: http://www.alz.org/alzheimers_disease_steps_to_diagnosis.asp

Mayo Clinic. (Dec 1, 2012). Hypothyroidism (underactive thyroid). [accessed 13 October 2015]. Retrieved from: http://www.mayoclinic.org/diseases-conditions/hypothyroidism/basics/symptoms/con-20021179

Medscape. (Jul 27, 2014). Alzheimer’s Disease Imaging. [accessed 13 October 2015]. Retrieved from: http://emedicine.medscape.com/article/336281-overview

National Institute on Aging. (June 2015). Alzheimer’s Disease Medications Fact Sheet. [accessed 13 October 2015]. Retrieved from: https://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-medications-fact-shee

Sources Cited