Clinical Case Study: A 74 year old woman was admitted to a long-term care facili

Question

Clinical Case Study:

A 74 year old woman was admitted to a long-term care facility. Her son reported that, over the past year he has noticed his mother progressively having problems with her mental capacity. The changes have developed gradually but have gotten worse. He reports that at times she is alert and other times she has been disoriented, depressed, and tearful.   She has been forgetting thins and doing things out of the ordinary. His neighbor found her down the street looking for his father who passed 2 years ago. Because her behavior has gotten worse and she has become more agitated she is no longer able to live alone. She has medical diagnoses of dementia, a history of transient ischemic attacks, congestive heart failure, status post–myocardial infarction, hypercholesterolemia, and a history of urinary tract infections (UTIs), and urinary incontinence. Two weeks after her admission, she is observed by the nursing staff to be more confused and agitated over the past few days. She falls asleep during meals, and upon awakening, she is disoriented to place and time, thinking she is only visiting at the nursing home. She frequently calls out for her son and becomes combative and is always trying to leave the nursing home. These are new behaviors for this patient. The night staff report she is confused, and they have overheard her talking to her son during the night. Before this week, she was slightly confused, extremely courteous older women. The CNA reports the resident’s urine is foul smelling and dark in color.

What are some cognitive changes seen in a number of elderly?

Based on the information provided by the nursing staff do you believe the patient is experiencing delirium or dementia?

What type of test would be used to diagnose dementia?

What do you suspect has caused the most recent increase in the resident’s confusion, disorientation, and behavioral outbursts?

What medications would you suspect that she would be taking for her diagnosis of dementia?

Explanation / Answer

1.a Cognitive changes in the Elderly:

1.b. The above information confirm that the patient is suffering from Dementia. Because she has developed the symptoms gradually but Delirium occurs abruptly . The other hallmark difference separating delirium from dementia is inattention.

!.c.Test to Diagnose Dementia:

- Medical history,

-Physical examination,

-Mini-Mental Status Examination (MMSE)

-Alzheimer’s Disease Assessment Scale-Cognitive neuropsychological Testing

-Brain imaging techniques

- Computed tomography

- Magnetic Resonance Imaging

- Positron Emission Tomography (PET) and Single-Photon Emission Computerized Tomography

-Routine laboratory tests used in the diagnosis of dementia include:

- Urine tests to investigate infection.

1.d.More recently the resident has increased occurence of Confusion,disorientation and behavioral outbursts because the urinary tract infection has progressed causing increase in blood urea and other discomforts.

1.e Medications that she would be taking for Dementia:

· -Cholinesterase inhibitors and Memantine.

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