NR 507 Week 7 Discussion; Alzheimer's Disease

Case Scenario A76-year -old man is brought to the primary care office by his wife with concerns about his worsening memory. He is a retired lawyer who has recently been getting lost in the neighborhood where he has lived for 35 years. He was recently found wandering and has often been brought home by neighbors. When asked about this, he becomes angry and defensive and states that he was just trying to go to the store and get some bread. His wife expressed concerns about his ability to make decisions as she came home two days ago to find that he allowed an unknown individual into the home to convince him to buy a home security system which they already have. He has also had trouble dressing himself and balancing his checkbook. At this point, she is considering hiring a day-time caregiver help him with dressing, meals and general supervision why she is at work. Past Medical History: Gastroesophageal reflux (treated with diet); is negative for hypertension, hyperlipidemia, stroke or head injury or depression Allergies: No known allergies Medications: None Family History • Father deceased at age 78 of decline related to Alzheimer'sdisease • Mother deceased at age 80 of naturalcauses • Nosiblings Social History • Deniessmoking • Denies alcohol or recreational druguse • Retired lawyer • Hobby: Golf at least twice aweek Review of Systems • Constitutional: Denies fatigue or insomnia • HEENT: Denies nasal congestion, rhinorrhea or sorethroat. • Chest: Denies dyspnea orcoughing • Heart: Denies chest pain, chest pressure orpalpitations. • Lymph: Denies lymph nodeswelling. • Musculoskeletal: denies falls or loss of balance; denies joint point orswelling General Physical Exam • Constitutional: Alert, angry butcooperative • Vital Signs: BP-128/72, T-98.6 F, P-76, RR-20 • Wt. 178 lbs., Ht. 6'0", BMI 24.1 HEENT • Head normocephalic; Pupils equal and reactive to light bilaterally; EOM'sintact Neck/Lymph Nodes • No abnormalitiesnoted Lungs • Bilateral breath sounds clear throughout lungfields. Heart • S1 and S2 regular rate and rhythm, no rubs ormurmurs. Integumentary System • Warm, dry and intact. Nail beds pink withoutclubbing. Neurological • Deep tendon reflexes (DTRs): 2/2; muscle tone and strength 5/5; no gait abnormalities; sensation intact bilaterally; noaphasia Diagnostics • Mini-Mental State Examination (MMSE): Baseline score 12 out of 30 (moderatedementia) • MRI: hippocampalatrophy • Basedontheclinicalpresentationanddiagnosticfindings,thepatientisdiagnosedwithAlzheimer'stypedementia. Discussion Questions 1. Compare and contrast the pathophysiology between Alzheimer's disease and frontotemporaldementia. 2. Identify the clinical findings from the case that supports a diagnosis of Alzheimer'sdisease. 3. Explain one hypothesis that explains the development of Alzheimer'sdisease 4. Discuss the patient's likely stage of Alzheimer'sdisease.