Alzheimer

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍cognitive impairment

Specific difficulties: ‍remembering namesremembering appointments

Onset was ‍gradualsuddenprogressive

Impact on daily activities is ‍minimal

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍confusion

‍disorientation

‍difficulty concentrating

‍mood changes

‍anxiety

‍depression

‍difficulty finding words

‍getting lost in familiar places

‍aphasia

‍apraxia

‍agnosia

‍agitation

‍irritability

‍social withdrawal

‍apathy

‍misplacing items

‍difficulty planning or solving problems

‍sleep disturbances

‍loss of appetite

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional



Contributing factors:

‍cardiovascular risk factors

‍smoking

‍alcohol use

no history of: ‍Alzheimer's disease, ‍dementia, ‍stroke, ‍head trauma, ‍thyroid problems, ‍vitamin B12 deficiency, ‍depression

no use of: ‍sedatives, ‍antidepressants, ‍antihistamines, ‍new medication

no family history of: ‍Alzheimer's disease, ‍dementia





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Metrics: weight: ‍ ‍kglbs, height: ‍ cm, waist: ‍ cm, BMI: ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Neurologic:

- Mental status: ‍alert, oriented to ‍3 spheres, speech ‍intact

- Cranial nerves: ‍all intact

- Strength: ‍intact 5/5 throughout except for ‍4/5 on ‍rightleft ‍, ‍pronator drift

- Sensation: ‍intact throughoutdecreasedabsent to ‍light touch on ‍

- Reflexes: ‍intact 2+ throughout except for ‍1+ on ‍rightleft ‍, ‍plantar downward

- Cerebellar function: ‍intact, ‍normalimpaired finger-nose, ‍normalimpaired rapid alternating movements, ‍normalimpaired heel-shin, Romberg ‍negative, Dix-Hallpike ‍negative

- Gait: ‍steadyunsteady, ‍intactimpaired tandem gait, ‍intactimpaired heel walk and toe walk

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Neurocognitive disorder ‍likelysuspectedpossible

DDx: major neurocognitive disorder, minor neurocognitive disorder, Alzheimer's disease, vascular neurocognitive disorder, Lewy bodies dementia, frontotemporal neurocognitive disorder, traumatic brain injury, alcohol-induced neurocognitive disorder, Wernicke encephalopathy, Korsakoff syndrome, substance-induced neurocognitive disorder, neurocognitive disorder due to HIV infection, prion disease, Parkinson's disease, Huntington's disease, neurocognitive disorder due to multiple etiologies, depression, schizophrenia, delirium, normal age-related cognitive decline, nutritional deficiencies, endocrine disorders, infectious diseases, autoimmune disorders, seizure disorders, chronic substance use, environmental toxins





PLAN:

Investigations:

- Blood work: ‍CBC, ‍TSH, ‍B12, ‍folate, ‍electrolytes, ‍creatinine, ‍LFTs, ‍glucose, ‍calcium, ‍HIV test, ‍syphilis test

- Urinalysis

- CT scan of the head

- MRI of the head

- Neuropsychological evaluation

- Lumbar puncture if infection or prion disease suspected

Treatments:

- Psychoeducation about neurocognitive disorders

- Cognitive exercise

- Regular physical exercise

- Balanced diet

- Regular sleep schedule

- ‍Cholinesterase inhibitors

- ‍NMDA receptor antagonists

- ‍Antidepressants

- ‍Antipsychotics

- Home safety assessment

- Occupational therapy

- Physical therapy

Further care:

- Further information to obtain from family

- Referral to geriatrician

- Referral to neurologist

- Referral to social worker

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen or if new symptoms develop such as confusion, memory loss, or changes in behavior or mood