1. Read the case study below.
2. In your initial discussion post, answer the questions related to the case scenario
and support your response with at least one evidence-based reference by Wed.,
11:59 pm MT.
3. Provides a minimum of two responses weekly on separate days; e.g., replies to a
post from a peer; AND faculty member’s question; OR two peers if no faculty
question using appropriate resources, before Sun., 11:59 pm MT.
Case Scenario
A 76-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 while 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's disease
Mother deceased at age 80 of natural causes
No siblings
Social History
Denies smoking
Denies alcohol or recreational drug use
Retired lawyer
Hobby: Golf at least twice a week
Review of Systems
Constitutional: Denies fatigue or insomnia
HEENT: Denies nasal congestion, rhinorrhea or sore throat.
Chest: Denies dyspnea or coughing
, Week 7 DB – Dementia
Heart: Denies chest pain, chest pressure or palpitations.
Lymph: Denies lymph node swelling.
Musculoskeletal: denies falls or loss of balance; denies joint pain or swelling
General Physical Exam
Head normocephalic; Pupils equal and reactive to light bilaterally; EOM's intact
Neck/Lymph Nodes
No abnormalities noted
Lungs
Bilateral breath sounds clear throughout lung fields.
Heart
S1 and S2 regular rate and rhythm, no rubs or murmurs.
Integumentary System
Warm, dry and intact. Nail beds pink without clubbing.
Neurological
Deep tendon reflexes (DTRs): 2/2; muscle tone and strength 5/5; no gait
abnormalities; sensation intact bilaterally; no aphasia
Diagnostics
Mini-Mental State Examination (MMSE): Baseline score 12 out of 30 (moderate
dementia)
MRI: hippocampal atrophy
Based on the clinical presentation and diagnostic findings, the patient is diagnosed
with Alzheimer's type dementia.
Discussion Questions
1. Compare and contrast the pathophysiology between Alzheimer's disease and
frontotemporal dementia.
Alzheimer’s disease is the most common neurodegenerative disease in the world and
is a progressive disease that results in impaired cognitive function. While the exact
cause is unknown, it is more common in women with risk factors including age, family
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