Discussion post
high-level scholarly reference in APA from within the last 5 years for each discussion. Thank you
1. Geriatrics
A 72 year-old female patient is brought in to the clinic by her daughter for her annual wellness exam. Her daughter reports that over the past year it seems that the patient’s memory and physical mobility have declined. The daughter requests that you test her mother for Alzheimer’s. Explain how you would assess this patient, state your top 3 differential diagnoses, and describe what your initial treatment plan would be.
Commonly, there is a general decline in physical functionality among the elderly population, leading to family members being worried. When there is cognitive impairment, mobility impairment follows as they go hand in hand (Avsar et al., 2021). Cognition appeared similar affiliations with incident loss of the capacity to ambulate. Linear mixed-effects models appeared that global cognition at pattern was related to the rate of declining mobility. My assessment will include checking the patient’s medical history and other clinic visits from the past. A focused neurological examination which includes functional assessment and cognitive testing, should also be performed (Bogolepova et al., 2022). Laboratory tests CBC count, erythrocyte sedimentation rate, glucose level, renal and liver function tests, vitamin B-12 and red blood cell folate levels, and thyroid function tests to rule out dementia. Imaging tests like MRI of the brain to check for any blood vessel abnormalities.
Differential Diagnoses:
a. Dementia – most likely because of his age, a decline in memory due to changes in the brain’s blood supply. There is an increased risk of dementia as a person ages, and specific molecules involved in the illness, named tau-proteins, spread more effortlessly within the aging brain. There is also mobility decline in a person with this disease because of neurodegenerative changes (Mei, 2021).
b. Cardiovascular disease – specifically arteriosclerosis, contributes to vascular dementia caused by the brain’s decreased blood supply because of the arteries’ hardening (Fu et al., 2022).
c. Depression – Social confinement and sadness are common in the geriatric population, and everybody needs social associations to outlive and flourish. However, as individuals age, they frequently discover themselves investing more time alone. Moreover, people who had depression late in life have a higher risk of having dementia (Jung et al., 2022).
The laboratory tests and imaging mentioned above will be part of my treatment plan. For a person with dementia, I will start him with donepezil 5 mg PO qHS as it enhances cholinergic transmission relieving symptoms of dementia (Sreedhar, 2022). I will educate the patient about side effects such as nausea, vomiting, and diarrhea. I will advise the patient’s family member to keep the surroundings place for the patient. Simple tasks are also recommended for people who have dementia. Advise light exercises like walking to improve strength, balance, and cardiovascular health. Recommend art therapy that can promote relaxation (Liu et al., 2021).
References
Avsar, P., Budri, A., Patton, D., Walsh, S., & Moore, Z. (2021). Developing algorithm based on activity and mobility for pressure ulcer risk among older adult residents: Implications for evidence‐based practice. Worldviews on Evidence-Based Nursing. https://doi.org/10.1111/wvn.12545
Bogolepova, A., Makhnovich, E., & Jyravleva, A. (2022). Neuropsychological disorders in patients with glaucoma. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova, 122(1), 72. https://doi.org/10.17116/jnevro202212201172
Fu, C., Wu, Y., Liu, S., Luo, C., Lu, Y., Liu, M., Wang, L., Zhang, Y., & Liu, X. (2022). Rehmannioside a improves cognitive impairment and alleviates ferroptosis via activating pi3k/akt/nrf2 and slc7a11/gpx4 signaling pathway after ischemia. Journal of Ethnopharmacology, 289, 115021. https://doi.org/10.1016/j.jep.2022.115021
Jung, C., Mahmoud, N., El Samanoudy, G., & Al Qassimi, N. (2022). Evaluating the color preferences for elderly depression in the united arab emirates. Buildings, 12(2), 234. https://doi.org/10.3390/buildings12020234
Liu, Z., Yang, Z., Xiao, C., Zhang, K., & Osmani, M. (2021). An investigation into art therapy aided health and well-being research: A 75-year bibliometric analysis. International Journal of Environmental Research and Public Health, 19(1), 232. https://doi.org/10.3390/ijerph19010232
Mei, M. (2021). The role of lifestyle, cardiovascular factors and biomarkers on health status in older adults at risk of cognitive deterioration. Minerva Access. http://hdl.handle.net/11343/279435
Sreedhar, V. (2022). Phytochemical composition of nigella sativa extract as potential source for inhibiting β-amyloid aggregation: Significance to alzheimer’s disease – proquest. ProQuest. https://www.proquest.com/openview/eb55e32f0b5f7592094b2cc4b1620457/1?pq-origsite=gscholar
2. Explain how you would assess this patient
Alzheimer’s disease (AD) is a progressive, irreversible, degenerative neurologic disease that results in neuron death (Domino et al., 2021). Symptoms appear because nerve cells (neurons) in parts of the brain involved in cognitive function are damaged or destroyed and with the progression of the disease, neurons in other parts of the brain are damaged or destroyed. Finally, nerve cells in the brain that assist in carrying out basic bodily functions (Alzheimer’s Association, 2020).
Diagnosis requires thorough history, examination, cognitive testing, and potentially other diagnostic tests which will help exclude conditions like delirium, or urinary tract infection, (Domino et al., 2021). I will start assessment by asking about patient’s medical history, including mental history and a history of cognitive and behavioral problems, any drugs the individual is taking because some medications can produce similar side effects as what the patient has, other family members’ significant medical problems, such as whether they have Alzheimer’s disease or other dementias, diet, nutrition, and alcohol consumption. I will also include in the history Alzheimer’s Association 10 signs which includes
Memory loss that interrupts daily life
Difficulty finishing familiar tasks
Challenges in planning and problem-solving
New problems with words in speaking or writing
Trouble with visual images or spatial relationships
Changes in mood or personality
Losing things, losing ability to retrace steps
Decreased or poor judgment
Withdrawal from work or social activities
Confusion with time and place (Domino et al., 2021)
Physical examination will be done including checking vital signs, lungs, heart, speech and language, vision and hearing, gait, balance, reflexes, muscle strength and tone, tremor, abnormal movements as well as an assessment on depression by using PHQ-9 assessment tool (Domino et al., 2021).
Top 3 differential diagnoses
Alzheimer’s Disease
Dementia with Lewy bodies
Depression
Describe what your initial treatment plan would be
Orders will be placed for CBC with differentials; homocysteine level, chemistry panel, thyroid function, lipid panel, vitamin B12, ammonia level, ESR, C-reactive protein, HgbA1c, folate, rapid plasma regain, CT scan if MRI is contraindicated, as well as urinalysis and culture if indicated. All of these is to help rule out other noncognitive problems including infection, brain tumor and other inflammatory process (Domino et al., 2021).
First line medication that can be prescribed is Acetylcholinesterase inhibitors such as Donepezil (Aricept) 5 mg/day PO and can be increased to 10 mg/day after 1 month. Vitamin E 2,000 IU/day supplementation has been found to slow decline (Domino et al., 2021).
References
Alzheimer’s Association. (2020). 2020 Alzheimer’s disease facts and figures. The Journal of the
Alzheimer’s Association, 16(3), 391-460. https://doi.org/10.1002/alz.12068
Domino, F.J. (ed.). (2021). The 5-Minute Clinical Consult 2022 (30th ed.). Wolters Klumer:
Philadelphia, PA
