Assignment Instructions
- Compares and contrasts the pathophysiology between Alzheimer's disease and frontotemporal dementia. (CO1)
- Identifies the clinical findings from the case that supports a diagnosis of Alzheimer's disease. (CO3)
- Explain one hypothesis that explains the development of Alzheimer's disease (CO3)
- Discuss the patient's likely stage of Alzheimer's disease (CO4)
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 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'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
- Heart: Denies chest pain, chest pressure or palpitations.
- Lymph: Denies lymph node swelling.
- Musculoskeletal: denies falls or loss of balance; denies joint point or swelling
General Physical Exam
- Constitutional: Alert, angry but cooperative
- 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'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
- Compare and contrast the pathophysiology between Alzheimer's disease and frontotemporal dementia.
- Identify the clinical findings from the case that supports a diagnosis of Alzheimer's disease.
- Explain one hypothesis that explains the development of Alzheimer's disease
- Discuss the patient's likely stage of Alzheimer's disease.
Sample Answer
Compares and contrasts the pathophysiology between Alzheimer's disease and frontotemporal dementia. (CO1)
There are major similarities between the pathophysiology of Alzheimer's disease and Frontotemporal Dementia (FTD). The similarities manifest themselves in progressive alterations in personality, behavior, and language ability, brain atrophy, impairments in the cognitive domains, and clinical presentation. Differences between the two are witnessed in age diagnosis as FTD is diagnosed in the early 60s and Alzheimer's is discovered with advancement in age (Alzheimer's Association, 2024). Loss of memory is an early symptom of Alzheimer though advanced FTD lead to memory loss. The first noticeable symptom of FTD is behavior change and in Alzheimer's, behavioral changes occur at later stages. Individuals suffering from Alzheimer's experience difficulties in communicating as they have more problems remembering than those suffering from FTD. Additionally, delusions and hallucinations are common as Alzheimer's progresses but this is not common in FTD (Alzheimer's Association, 2024).
Identifies the clinical findings from the case that supports a diagnosis of Alzheimer's disease
There are various clinical findings that support the diagnosis of Alzheimer's. The Mini-Mental State Examination (MMSE) revealed that the patient was suffering from moderate dementia. An MMSE is used to examine cognitive impairment in the form of problems in memory and understanding, communication, and thinking. The Hippocampal atrophy as seen in the Magnetic Resonance Imaging (MRI) is an early symptom of Alzheimer's disease. Additionally, the patient has a family history of Alzheimer's as the father died at 78 years due to a decline related to Alzheimer's disease.
Explain one hypothesis that explains the development of Alzheimer's disease
One of the hypotheses that explain the development of Alzheimer's disease is the cholinergic hypothesis. The cholinergic hypothesis was presented 20 years ago and it suggested that the dysfunction of acetylcholine-containing brain neurons contributed to cognitive decline in Alzheimer's and during old age (Smith, 2022). This hypothesis has served as the basis for the development of drugs and treatment surgeries for treating Alzheimer's.
Discuss the patient's likely stage of Alzheimer's disease (CO4)
The patient is likely to be in Middle-Stage Alzheimer's (moderate). The middle stage is usually the longest and it is characterized by the progressing of the condition. Some of the symptoms of moderate Alzheimer's are; being forgetful, feeling moody, inability to recall important information, confusion, and requiring help to choose proper clothing. The patient is experiencing these symptoms as recently, he got lost in the neighborhood and was brought back by the neighbors (Alzheimer's Association, 2024). On being asked, he became very angry and defensive. Additionally, the wife is worried about his ability to make decisions as he has purchased a home security system that they already have. At this point, the patient requires more supervision and the wide is considering hiring a caregiver to help him with meals, dressing, and general supervision.
References
Alzheimer's Association. (2024). Frontotemporal dementia. Alzheimer's Disease and Dementia. https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/frontotemporal-dementia
Smith, A. (2022). Discussing major hypotheses of Alzheimer's disease. News Medical Life Sciences. https://www.news-medical.net/whitepaper/20220530/Discussing-major-hypotheses-of-Alzheimers-disease.aspx