In this case study, Mr. M, a 70-year-old man, experiences the symptoms of deteriorating memory and disorientation in time and space. The patient lives in the assisted living facility, and he is mentioned as a person who could indecently dress, eat, and perform other daily activities. The evaluation shows that Mr. M faces difficulties with remembering his room number and family members, while also failing to recall the stories he read a few minutes ago. These symptoms are representative of Alzheimer’s disease, which will be discussed in this paper.
Identifying a Patient’s Condition
Today, Alzheimer’s disease is the most common cause of dementia among older adults, and it accounts for 60-80% of cases of this syndrome (Alzheimer’s Association, 2015). This disorder affects such vital skills as memory, speech, orientation in space, the ability to adequately perceive the environment, and problem-solving abilities, which are pertinent to Mr. M. Namely, the loss of short-term memory, for example, patients ask repeated questions, often put objects in their place or forget their purpose, points to Alzheimer’s disease as the primary diagnosis. This also includes requests to repeat the same information several times, a growing reliance on written reminders, and difficulty recalling recent events.
Among the secondary diagnoses, one may note frontotemporal dementia, according to which the patients experience problems with memory, movement, and habitual actions, complaining about poor appetite, and lose self-service skills. Frontotemporal dementia, in which most of the degenerative alterations appear in the anterior temporal lobes as well as frontal lobes of the brain, affects people under 65 years of age (Brenowitz et al., 2017). The areas of the brain that are damaged in patients with this form of dementia are responsible for personality traits, behavior, and speech. Since Mr. M shows impulsive and aggressive behavior, it was possible to consider this diagnosis, yet his age is not characteristic of it. Levy body dementia is another secondary diagnosis that refers to cognitive disorders characteristic of the given patient. However, these symptoms appear simultaneously with motor disorders (stiffness of movements, shuffling gait like in Parkinson’s disease (Brenowitz et al., 2017). Significant fluctuations in the severity of cognitive impairment are not mentioned in this case, which makes Alzheimer’s disease the main diagnosis.
The nursing assessment of Mr. M can reveal a range of concomitant symptoms that will allow for approving the suggested diagnosis. It is expected to detect problems with recalling words and saying something like “this thing that cooks food” and failing to properly name it. The evaluation may also find abnormalities in perceiving depth, distance, and recognizing family members. For patients with dementia, it may become difficult to climb or go down the stairs, find the way home, or even read books. Disorientation also includes the inability to determine the time of year or location, while with advanced Alzheimer’s disease, the patient may consider himself younger than he actually is due to the loss of a sense of time.
Speaking of the physical impact, the identified disease makes on the patient, one should stress that Mr. M experiences the impairment of his muscles and the reducing ability to control his body. From the psychological point of view, he seems to be afraid of sudden changes, feeling confusion, loneliness, and anxiety (Martinez et al., 2016). The patient understands that something wrong with him when he finds himself at night outside the bed in the hall, yet he cannot realize how and why he is there. The patient’s family also suffers from losing relationship ties with the close one and feeling helpless because of the inability to help. Accordingly, the two actual problems faced by Mr. M are memory loss and the performance of daily activities, which are the first symptoms of Alzheimer’s disease. Two more potential problems are agnosia, a violation of different types of perception, including tactile, visual, and auditory, and apathy turning to depression, which is caused by more significant brain damage.
Drug therapy is the first step to impact the pathological process in the brain of Mr. M. In Alzheimer’s disease, the drugs are prescribed that block cholinesterase and prevent the formation of amyloid and plaques, including donepezil or rivastigmine. Moreover, rivastigmine is also prescribed in the form of a patch that must be glued to the skin (Birks & Evans, 2015). The above drugs can improve memory and speech, help in concentrating attention, and accelerate reactions. Thioridazine is used to relieve aggressiveness and impulsivity and fight insomnia. Psychosocial therapy complements medication and allows patients in the early stages of Alzheimer’s disease to adapt to the disease. The work with memories, communication, and assignment of intellectual tasks stimulate the brain and positively affect the patient’s psycho-emotional state.
To conclude, Mr. M was diagnosed with Alzheimer’s disease based on his symptoms of short-term memory loss, insomnia, the reducing ability to recognize his family, and so on. Levy body dementia and frontotemporal dementia were identified as secondary diagnoses yet eliminated due to variance in some vital characteristics. The nursing assessment showed that the patient’s dementia is likely to deteriorate, causing further memory, movement, perception, and self-service impairments. Both medication and psychosocial therapies were recommended specifically to Mr. M’s current condition.
Alzheimer’s Association. (2015). 2015 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 11(3), 332-384.
Birks, J. S., & Evans, J. G. (2015). Rivastigmine for Alzheimer’s disease. Cochrane Database of Systematic Reviews, 4(4), 1-197.
Brenowitz, W. D., Keene, C. D., Hawes, S. E., Hubbard, R. A., Longstreth Jr, W. T., Woltjer, R. L.,… Kukull, W. A. (2017). Alzheimer’s disease neuropathologic change, Lewy body disease, and vascular brain injury in clinic-and community-based samples. Neurobiology of Aging, 53, 83-92.
Martinez, M., Multani, N., Anor, C. J., Tang-Wai, D. F., Keren, R., Fox, S.,… Tartaglia, M. C. (2016). Changes in emotion detection and empathy in Alzheimer’s disease and Parkinson’s disease affect care partner mood. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 12(7), 299.