Case Study 3 Dementia.pptx on Handling Dementia

Dementia

1. CLINICAL CASE STUDY 3: DEMENTIA Student’s Name Institutional Affiliation Course Instructor’s Name Date

2. Introduction Dementia is described as the loss of cognitive functioning, including memory, reasoning, and thinking, to the extent that it disrupts a person’s daily life. Dementia inhibits emotional regulation in some people, resulting in mood disorders and periodic aggression. Alzheimer’s disease is the most common version of Dementia, affecting older adults at least 65 years of age ( Arvanitakis et al., 2019) . There are many possible causes and symptoms of Dementia, making it essential for potential patients to undergo comprehensive psychiatric evaluations. In this presentation, we will look at the case of a new patient of diagnosis age 75, displaying the onset of aggression and memory loss.

3. Consent for Treatment Law and professional codes of conduct obligate medical practitioners responsible for performing psychiatric evaluations to collect informed consent from their patients. Such approval involves the patient and close family members comprehensively understanding the proposed treatment approaches, risks, benefits, and duration. In this case, informed consent must be acquired from the spouse or the next of kin since the patient does not have mental competence. After introducing myself to the husband, the son, and the daughter-in-law, I was able to secure verbal consent for the evaluation. Consent meant I could collect more information from the family. The husband gave formal consent by signing related health documents. CONSENT!!!!!

4. Case Presentation PATIENT PROFILE Include essential demographic information such as age, gender, and medical history. Describe the patient's chief complaint and the timeline of symptoms leading to the final diagnosis Female, aged sixty-five, currently not on any psychiatric medications or therapies. The patient presents to the clinic today with the suspected onset of Dementia. The patient has been slowly forgetting crucial details. The daughter claims the patient has been throwing regular feats of aggression. Medical data shows the patient has a history of hypertension and suffers from type 2 diabetes. The spouse and family want to clarify that it is indeed Dementia that could be affecting the elderly woman since they are noticing a gradual shift in personality, functionality, and temperament.

5. The family has not been actively or formerly monitoring the patient’s condition. The daughter claims their observations have been irregular, triggered when the patient forgets something. However, according to the husband, the patient has been forgetting critical information for the last year. It was when she forgot two of her grandchildren’s names and faces that it was recommended she undergo a psychiatric evaluation. The aggression is more recent and less pronounced. The family is unsure if the current change in temperament is associated with her mental condition. The family has only started with her monitoring, thus their decision to come in for a psychiatric evaluation. Patient Medical History

6. Assessment of Supports The assessment of supports begins with asking the patient what her typical day looks like. Upon asking this question, I was informed that she receives home-based care due to her age. A private nurse often comes in the morning, stays with the couple, and helps them with errands, including gardening, knitting, and shopping. As soon as they wake up, they are directed to the showers, breakfast, then gardening. They often go for walks or visit friends and family in the afternoon. In the evening, they have a retirees’ club where they socialize with peers and plan vacation activities. My interview showed that all family members comprehensively understand what their mother does during the day. She has sufficient love, compassion, and care from family members.

7. Mental Health History Understanding Patient Info: There is no evidence to suggest the patient suffers from any cognitive disorders. She has not been under any psychiatric medications or therapies in the past, nor has she ever been institutionalized for any mental condition. However, there was evidence of underlying physiological conditions as the patient is under medication for type 2 diabetes and hypertension. Whether the two chronic conditions have contributed to her suspected mental disorder is yet to be established.

8. Developmental/EDU Assessment Gallegos et al. (2022) claim that the Mini‐Mental State Examination (MMSE) for the early detection of Dementia provides a solid framework for assessing progressive cognitive decline and change in personality. The goal of the assessment was to validate whether the patient was experiencing Mild Cognitive Impairment (MCI), which often progresses to Dementia. From the patient and family interviews, I gathered that the patient and the spouse were highly successful engineers. Over the years, they built a structural engineering consultancy firm, which they sold as part of their retirement plan. Therefore, no emotional problems detected could underlie an MCI diagnosis. However, I also gathered that the patient had been injured during a company machinery work accident. A bolt had come off a company trolley, knocking her on the head causing a concussion with at least a week of confusion and disorientation.

9. Mental Status Exam General Observations: While the patient’s appearance looked neat, her mind seemed disoriented. There was a significant loss in the level of alertness as the patient kept jumping from topic to topic and object to object. Her respiratory rate was abnormal at 119 beats per minute, while her temperature was within the normal range of 36.1 degrees Celsius. The patient was not wheezing or showing increased breathing or dyspnea. The measurements imply the patient has her type 2 diabetes and hypertension under control, meaning effective pharmacological interventions. Main concern: Is the patient’s two chronic ailments contributing to an affirmative diagnosis of dementia?

10. Developmental and Physical Assessment Start HEENT General Status Neck 1 2 3 Normal breathing rate, no murmurs. The temperature was within the normal range of 36.1 degrees Celsius. The head and neck are of normal size and normal cephalic shape. No signs of trauma, such as wounds on the skull and scalp. The patient shows good response to smell, hearing, and eye movement. Optimal range of neck motion with the neck tilting from shoulder to shoulder. The shoulders do not show resistance to any shrugging.

11. Developmental and Physical Assessment Respiratory No Lungs CTA, dry coughs, wheezing. Cardiac No detected heart murmurs. Pulse rate slightly within normal range. Abdomen There are no indications of gastric muscle tenderness or ulcers. There were heavy bowel sounds with the tummy soft and distended. Pulse Pulses are palpable and present Extremities There are no observable points of bleeding, the thyroid glands are not inflamed, and the nasal passages are functioning well. Skin No abrasions, lesions, rashes. The patient feels dry but warm. Neurological The patient’s posture is off as she seems to lean forward with the sequence of arm and stride movements not in sync. The patient displays delayed responses to superficial touch and pain.

12. Neurological Assessment The DSM-5 criteria was integrated into the diagnostic process to determine whether the patient was showing symptoms of mild Dementia. According to the American Psychiatric Association (2013), the patient must demonstrate to be significantly impaired by at least one of the six neuro-cognitive domains. The Folstein Mini-Mental Examination was used to validate this impairment. According to the results, the 65-year-old patient had a cognitive decline that reduced her age to that of a 4th-grader. The patient registered a score of 23 instead of 29, which is associated with moderate cognitive impairment.

13. Differential Diagnosis Creutzfeldt-Jakob Disease : Often misdiagnosed for Dementia due to similarities in symptomology. The patient will display movement difficulties and mood disruptions ( Barnwal et al., 2022). Identified earlier was that the patient was suffering from poor coordination of arm and leg movements. The only way to confirm the diagnosis is through a brain biopsy, where a neuropathologist extracts and examines a small living tissue of the brain ( Barnwal et al., 2022). Alzheimer’s Disease (AD ): Alzheimer’s is the most common form of Dementia, with patients showing episodic memory loss. The goal will be to differentiate the sequence of symptoms to separate AD from Dementia. AD attacks sections of the brain associated with learning first, meaning early symptoms are memory loss and thinking gaps ( Breijyeh & Karaman , 2020). If the performance of daily activities was disrupted before or together with the learning problems, then the diagnosis is Dementia.

14. Assessment and Management Plan Diagnosis: Mid Dementia The patient shows impairments in at least two of the six cognitive domains, as there is a loss of memory, gaps in reasoning, and interference in executive functions. There is also a decline in perceptual-motor coordination. As aforementioned, the patient was seen struggling synchronizing her arm and leg movements. Treatment Plan Since the patient is experiencing the early onset of Dementia, treatment will focus on using mild medications to improve and manage the symptoms. The patient will be prescribed cholinesterase inhibitors, namely donepezil, which she will take 5mg daily for four to six weeks. After a follow-up visit to determine the patient’s response to the drug, the psychiatrist will decide whether to escalate the dosage to 10mg daily.

15. Conclusion Scientific literature outlines that dementia is a common cognitive disorder for elderly adults above the age of 65. Dementia refers to an umbrella term for a set of cognitive symptoms, including memory loss, decline in understanding and judgment, decline in competency to make rational decisions, changes in personality, and disruptions in daily activities. Detecting dementia early and identifying its sub-type is crucial to the provision of proper care, home and in-hospital. The case study depicts a senior lady experiencing the onset of dementia, with a gradual decline in memory and executive functioning. There is reason to believe her symptoms could have been caused by her underlying chronic conditions, type 2 diabetes and hypertension, and their respective medications. The patient will be prescribed cholinesterase inhibitors, namely donepezil to reduce the severity of symptoms.

16. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5 th Ed) . American Psychiatric Publishing. Arevalo-Rodriguez, I., Smailagic , N., Roqué-Figuls , M., Ciapponi , A., Sanchez-Perez, E., Giannakou , A., Pedraza, O. L., Bonfill Cosp , X., & Cullum, S. (2021). Mini-Mental State Examination (MMSE) for the early detection of Dementia in people with mild cognitive impairment (MCI).  The Cochrane Database of Systematic Reviews ,  7 (7), CD010783. https://doi.org/10.1002/14651858.CD010783.pub3 Arvanitakis , Z., Shah, R. C., & Bennett, D. A. (2019). Diagnosis and management of Dementia: Review.  JAMA ,  322 (16), 1589–1599. https://doi.org/10.1001/jama.2019.4782 Barnwal , S., Jha , G., Sola, S. C., Anand , P., & Shariff , S. Y. (2022). Creutzfeldt-Jakob disease: A case report and literature review for understanding the big picture.  Cureus ,  14 (11), e31303. https://doi.org/10.7759/cureus.31303 Gallegos, M., Morgan, M. L., Cervigni , M., Martino, P., Murray, J., Calandra , M., Razumovskiy , A., Caycho -Rodríguez, T., & Gallegos, W. L. A. (2022). 45 Years of the mini-mental state examination (MMSE): A perspective from Ibero -America.  Dementia & Neuropsychologia ,  16 (4), 384–387. https://doi.org/10.1590/1980-5764-DN-2021-0097