Clinical Manifestations

Clinical Manifestations

Mr. M is a 70-year old male presented with rapid cognitive deterioration that began two months ago characterized by trouble recalling names of familiar people and places, increased forgetfulness, increased aggressiveness and agitation and fear. He wanders at night and gets lost. He performs limited physical activity related to difficulty ambulating and unsteady gait. Since the cognitive decline, Mr. has been unable to perform basic ADLs like bathing, feeding or dressing himself. Initial physical exam shows T:37.1C, BP: 123/78, HR: 93, RR 22, Pox 99%, H:65.5 inches, W: 87 kg. Laboratory screening is normal, WBC count =1000/uL, lymphocytes count at 67000uL. Urinalysis positive for moderate amount of leukocytes and cloudy, and protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L. His medical history is relevant for hypertension controlled with ACE inhibitors and hypercholesterolemia. His surgical history includes status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. He has no history of alcohol or smoking.

Primary and Secondary Medical Diagnoses

Based on the clinical manifestations, moderate Alzheimer dementia should be considered as the primary diagnosis for Mr. This will require interviewing Mr. M and family and friends as well as evaluating reports from the Assisted Living Facility workers. Testing for dementia involves careful examination of medical history, conducting physical examination and observing personality/behavior changes and day-to-day function to rule out other conditions (Martorelli, Sudo, & Charchat-Fichman, 2019). Generally, patients with dementia experience memory problems, behavior/personality changes, loss of capacity to perform ADLs, increased confusion and asking same question over and over. Dementia affects older people and Alzheimer’s disease is the leading cause (Wells, 2019). Other causes include infection of the CNS, traumatic brain injuries and vascular disorders. Mr. M exhibits memory loss, trouble remembering common people and places, and rapid cognitive decline. He has deficits in basic activities of daily living perform. He wanders at night due to confusion, gets lost, and gets agitated and aggressive quickly. These problems have affected his ability to manager his daily life.

The consideration of secondary diagnoses should be based on neuropsychological and cognitive tests, mental status exam, blood tests, neurological evaluation and brain scans to assess cognitive function, brain activity, language and memory (Falkner, & Green, 2018). Urinalysis and blood tests would help rule out the possibility of diabetes, kidney disease, vitamin B-12 deficiency thyroid disorders. Brain imaging and scan rule out the possibility of having stroke, brain hemorrhage or Parkinson’s disease and establish a baseline regarding the degree of degeneration (Falkner, & Green, 2018). Neuropsychological and mental status testing assess cognitive skills and identify memory problems.

Abnormalities 

Brain imaging showed an insidious progression of moderate cerebral or cortical atrophy in the media temporal lobe. Cortical atrophy is characterized by multimodal association cortices and limbic lobe structures (Ture, & Dickson, 2019). Hippocampus and amygdala are the earliest sites for atrophy. Atrophy is the degeneration of the brain (Falkner, & Green, 2018). The cortex appear wrinkled with ridges of tissue. The development of neurofibrillary tangles and accumulation of beta-amyloid identified under PET (Angelucci, Cechova, Amleva, & Hort, 2019). Dementia of Alzheimer’s disease results in nerve cell death and tissue loss, causing the brain to shrink and loss functional capacity. According to Lee, Kim, Hong and Kim (2019), neurofibrillary tangles, neuritic plaques, and beta-amyloid deposition are observed in the brain of patients with Alzheimer’s disease

Physical, Psychological, And Emotional Effects Mr. M.’s current health status

Dementia burdens the patient and family with physical and emotional stress. Brain changes start to affect physical function like balance, swallowing, fatigue and bowel control. Loss of balance and coordination and stiff muscles are common in dementia. All these symptoms reduce the ability to perform ADLs. Mr. M. is unable to engage in physical activity due to difficulty in ambulating and gait. The loss of independence to perform ADLs add to more fear. A person diagnosed with Alzheimer’s disease exhibit a range of emotions such as fear, anger, aggression, apathy and loss. The severity of these symptoms is predictive of rapid decline. Severity of dementia is correlated with verbal aggression and physical agitation. As for the family, financial strain and work-related stress are the main impacts. Dementia increases the financial burden for the patient and family. Caregiving is very stress given that many family members lack medical experience to provide desired care. Caregivers struggle to balance family responsibilities.

Interventions to support Mr. M. And his family

The first intervention that would be implemented to support Mr. M. and his family is restoration of function. This intervention aims to restore and maintain health and functioning. physical therapies focus on improving quality of life and maximizing physical and cognitive functioning (Falkner, & Green, 2018). the next intervention is encouraging independence and self-care through ADLs. Training ADLS skills to the patient, promoting exercise, writing out schedules and establishing routines can help promote independence in patients with dementia.  Promoting independence is important in instilling a self of self-worth and dignity. Patients who rely heavily on caregivers undermine their independence and ability to self-care.  Use of adaptive aids and assisted technologies are key to promoting independence in people with dementia. Because Mr. M. has trouble recalling house number and names of family members, use of signs, labels and notes help remind them. Link the patient and family to support and resources can also be helpful. Caregivers can require resources and emotional support to cope with the situation and provide psychological care (Falkner, & Green, 2018).

Four Actual or Potential Problems He Faces

Mr. M has become dependent on others to perform ADLs like bathing, feeding and dressing. Loss of independence and inability to perform personal care can be very stressful experience. The rapid cognitive decline has caused him to lose memory, as in forgetting names of familiar people and places, getting lost. Personality changes cause the patient to be aggressive, increasing the risk of self-harm. Because of hypercholesterolemia and hypertension, Mr. M. is at risk for developing chronic conditions like diabetes mellitus, hyperthyroidism and cardiovascular failure. The symptoms may worsen over time, putting the patient at greater risk and making specialized care more important.

References

Angelucci, F., Cechova, K., Amleva, J. & Hort, J. (2019) Antibiotics, gut microbiota, and Alzheimer’s disease. Journal of Neuroinflammation, 16(108). https://doi.org/10.1186/s12974-019-1494-4. https://jneuroinflammation.biomedcentral.com/articles/10.1186/s12974-019-1494-4#citeas

Falkner, A. & Green, S.Z. (2018). Neurological, Perceptual, and Cognitive Complexities. In Pathophysiology Clinical Applications for Client Health. https://lc.gcumedia.com/nrs410v/pathophysiology-clinical-applications-for-client-health/v1.1/#/chapter/2

Lee, J., Kim, S., Hong, S., & Kim, Y. (2019). Diagnosis of Alzheimer’s disease utilizing amyloid and tau as fluid biomarkers. Experimental & Molecular Medicine, 51: 1-10 https://www.nature.com/articles/s12276-019-0250-2

Martorelli, M., Sudo, F. K., & Charchat-Fichman, H. (2019). This is not only about memory: A systematic review on neuropsychological heterogeneity in Alzheimer’s disease. Psychology & Neuroscience, 12(2), 271–281. https://doi.org/10.1037/pne0000149. https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=pdh&AN=2018-47217-001&site=eds-live&scope=site

Ture, M.A., & Dickson, D.W. (2019). Molecular Neurodegeneration, 14(32). https://doi.org/10.1186/s13024-019-0333-5. https://molecularneurodegeneration.biomedcentral.com/articles/10.1186/s13024-019-0333-5#citeas

Wells, J. (2019). Case Report of a 63-Year-Old Patient with Alzheimer Disease and a Novel Presenilin 2 Mutation. Alzheimer Disease & Associated Disorders, 33(2)166-169. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6554015/

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