CASE 32 - Forgetfulness And Confusion

Question 1

Do you think I have Alzheimer’s disease?

Answer 1

At this time I don’t know; we still need to run some tests.

What makes you concerned about having Alzheimer’s?

Question 2

Specific Qs:

Answer 2

1. Things that are difficult to remember ==> Turning off the stove, my phone number, my keys, the way home, the names of my friends.
2. Daily activities ==> Bathing, feeding, toilet, dress (DEATH questions).
3. Shopping — cooking — housework — paying the bills.
4. Gait problems — urinary incontinence — neuro Qs.
5. Depression.
6. Support system (family, friends).

Question 3

PEx:

Answer 3

1. Eye exam ==> Inspected pupils, fundus.
2. Neck ==> carotid auscultation.
3. CV ==> A + orthostatics.
4. Chest ==> A.
5. Abdo ==> P.
6. Neuro ==> mini-mental status exam, CNs, motor exam, DTRs, gait, Romberg’s sign, sensory exam.

Question 4

DDx:

Answer 4

1. AD.
2. VD.
3. FTD.
4. LBD.
5. PDD.
6. CJD.

+ NPH, B12, syph, HIV, hypothyroidism, subdural.

Question 5

Workup:

Answer 5

1. CT head or MRI brain.
2. EEG or SPECT.
3. CBC.
4. B12, TSH, RPR.
5. Electrolytes, calcium, glucose, BUN/Cr.
6. LP opening pressure.

Question 6

Q1:

Answer 6

Things that are difficult to remember ==> Turning off the stove, phone number, keys, the way home, the names of friends.

Question 7

Q2:

Answer 7

ADLs (bathing, feeding, toileting, dressing).

Question 8

MMSE:

Answer 8

1. Orientation ==> person, place, time.
2. Memory ==> Repeat 3 words — recall them later.
3. Attention and concentration ==> Spell “world” backwards.
4. Language ==> Name objects (pen, watch).
5. Obeys commands ==> Ask the pt to close her eyes.