Question

Scenario

You are the nurse working triage in the emergency department (ED). This afternoon a woman brings in her father, ALI, a 72-year-old who is a retired doctor. The daughter reports that over the past several months she has noticed her father has progressively had problems with his mental capacity. These changes have developed gradually but seem to be getting worse. At times he is alert, and at other times he seems disoriented, depressed, and tearful. He is forgetting things and doing things out of the ordinary, such as placing the milk in the cupboard and sugar in the refrigerator. He had difficulty finding objects in the kitchen and at times forgets where his room is.

This morning he thought it was nighttime and wondered what his daughter was doing at his house. He could not pour his coffee, and he seems to be getting more agitated. ALI reports that he has been having memory problems for the past year and at times has difficulty remembering the names of family members and friends.

A review of his past medical history (PMH) is significant for hypercholesterolemia and coronary artery disease (CAD). He had a myocardial infarction (MI) 5 years ago. ALI’s vital signs (VS) today are all within normal limits (WNL).

Q: You understand that other disorders may have presentations similar to dementia. Name one and discuss it?   

Answer 1

DEMENTIA- it is syndrome with progressive deterioration in intellectual functioning secondary to structural or functional changes. Long term or short-term memory loss occur with impairment in judgement.

Similar disorder is

ALZHEIMER’s DISEASE

It is an irreversible, progressive, chronic disease may affect the brain cell causes nerve cell deteriorations. Individual with Alzheimer’s experience cognitive and progressive loss of ability to carry out activities of daily living

Etiology or risk factor

1. Neurological factors- acetylcholine, somatostatin and norepinephrine

2. Use of cholesterol controlling drug in hypercholesteremia

3. Certain infection

4. Down syndromes

5. Heart disease

6. Chronic high blood pressure

7. Family history

8. Head injury

9. Gender

10. Smoking & drinking

Risk factor in client

1. Hypercholesteremia

2. CAD (coronary artery disease)

Heart disease have direct impact on the cognitive function of the brain due to development of atherosclerosis. As in atherosclerosis plaque formation occur due to high cholesterol and fatty substances. Plaque formation occur in the brain and immune response counteract the plaque formation due this causes a clump of protein around the brain cell. These proteins are hallmark (beta- amyloid plaques) of Alzheimer’s disease.

Sign and symptoms

     sign

1. Memory loos

2. Difficult to perform familiar task

3. Problems with language

4. Disoriented to time and place

5. Poor or decreased judgement

6. Problems with abstract thinking

7. Misplacing things

8. Change in mood or behavior

9. Change in personality

10. Loss of initiative

Symptoms

1. Confusion

2. Disturbance in short term memory

3. Problem with attention and partial orientation

4. Personality change and language difficulty

5. Unexplained mood changes

Sign and symptoms in patient

1. Disoriented to time and place (saying morning time to nighttime)

2. Memory loss (forgetting names)

3. Misplacing things (placing milk in cupboard and sugar in refrigerator

4. Difficulty to perform familiar task (not able to pour coffee in cup)

5. Unexplained mood changes (patient gets agitated and depressive)

Diagnostic test

- Physical examination

- Mental status examination to check about aware of symptoms, orientation to time place and person, follow instruction and do simple calculation etc.

- Imaging studies such as CT scan, MRI, x-rays and PET- to rule out other conditions causing Alzheimer’s like tumors, evidence of stroke and head injury.

- CSF examination- it helps in earlies diagnosis of Alzheimer’s, by detecting the tau and beta amyloid protein which are abnormal deposit in brain cells.

- EEG electroencephalogram- to assess Cortical neurofunctions and by assessing brain activities at different frequencies

TREATMENT

1. Pharmacological treatment

- Acetylinecholineratase inhibiters prevent the breakdown of acetylene, a chemical messenger necessary for learning and memory. It improves agitation and depression. Examples – donepezil, galantamine

These drugs have side effect like nausea, diarrhea etc.

- Memantine (Namenda)- it slows the progress of symptom by inhibiting the overstimulation of glutamate (neurotransmitter)

2. Supportive and safe environment for client, as Alzheimer’s have no cure and client don’t capable of doing his basis need, caregiver should carefully manage the case and promote safe environment

By using behavioral, emotional, cognition and stimulation oriented approach.

FOR ANY DOUBT A QUESTION, IT WILL BE HIGHLY APPRECIATED..