Jack Richards Katarina Mayer Makenzie Nelson 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.

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

 Hypothyroidism  Forgetfulness/ Memory loss  Stubbornness  Fatigue  Muscle Weakness  Depression  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

 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  points suggests mild dementia  points suggests moderate dementia  Less than 12 points suggests severe dementia  With Alzheimer’s, the points decline two to four points per year

 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

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 More about 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

 Perform mental status exams that may include a 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

 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

 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

 Medical College of Wisconsin. (nd.). Alzheimer’s Disease Treatment and Prognosis. [accessed 9 October 2015]. Retrieved from:  Alzheimer’s Association. (nd.). Treatments for Alzheimer’s disease. [accessed 13 October 2015]. Retrieved from:  Alzheimer’s Association. (nd.). Treatments for Behavior. [accessed 13 October 2015]. Retrieved from:  Everyday Health. (nd.). Assembling Your Alzheimer’s Care Team. [accessed 13 October 2015]. Retrieved from:  Alzheimer’s Association. (nd.) Tests for Alzheimer’s Disease and Dementia. [accessed 13 October 2015]. Retrieved from:  Mayo Clinic. (Dec 1, 2012). Hypothyroidism (underactive thyroid). [accessed 13 October 2015]. Retrieved from:  Medscape. (Jul 27, 2014). Alzheimer’s Disease Imaging. [accessed 13 October 2015]. Retrieved from:  National Institute on Aging. (June 2015). Alzheimer’s Disease Medications Fact Sheet. [accessed 13 October 2015]. Retrieved from: medications-fact-sheehttps:// medications-fact-shee