Week 8 Discussion 1: Memory Loss HPI: 70-year-old African American woman, Selah, who is accompanied by her daughter, Britt, to the appointment. The PMH of the patient includes HTN, DM, Hyperlipidemia, TIA × 2

Week 8 Discussion 1: Memory Loss

HPI: 70-year-old African American woman, Selah, who is accompanied by her daughter, Britt, to the appointment. The PMH of the patient includes HTN, DM, Hyperlipidemia, TIA × 2, and Osteoarthritis of both knees, with multiple falls resulting in two diagnosed concussions. The daughter is concerned because she feels as if her mother’s memory isn’t what it used to be. Britt states that her mother sometimes misplaces things and forgets events, as well as the names of people she has known for a long period of time.

Differential Diagnoses

1. 
   Alzheimer’s Disease. AD has an insidious and progressive onset for symptoms (Dunphy et al., 2019). Common signs of the onset of disease are seen by family members who start noticing changes over time. Cognitive decline often seen in AD patients are an inability to learn new information or recall things they knew previously, aphasia, apraxia, agnosia, and weaknesses with executive function (Dunphy et al., 2019). This patient is displaying signs of learning and memory deficits. She is having issues with misplacing familiar items and forgets events, and names of people she knows well. These are all signs for further assessment of AD (Dunphy et al., 2019).
2. Depression. Symptoms of depression can mimic AD (Dunphy et al., 2019). Once older adults have multiple falls, they can be fearful of falling again (Kiel, 2022). Fears of falling are associated with depression as well as cognitive impairments (Kiel, 2022). Increased depression can be a sign of increasing dementia with AD (Dunphy et al., 2019).
3. Head Injury. Head injuries are a risk factor for Alzheimer’s disease (Dunphy et al., 2019). She takes two antihypertensive medications, an opioid for pain, and a blood thinner. Antihypertensive medications should be closely monitored in older adults due to the increased risk for falls (Kiel, 2022). I would want to check PT/PTT and platelets as well as a head CT to ensure she does not have any intracranial bleeding.
4. Drug-related dementia. Opioids can negatively affect cognitive function in older adults (Dunphy et al., 2019). However, this can be ruled out in this patient because she was prescribed pain meds a couple of months ago, and her daughter states her memory issues started 6 months ago. Another drug to be weary of is the Plavix. This is a blood thinner and she has two recent falls.

Final Diagnosis: Alzheimer’s Disease

Pharmacology

• 
  Donepezil (Aricept) (Dunphy et al., 2019).
  • Vitamin E (Dunphy et al., 2019)

Non-Pharmacology

• 
  Keeping a Routine
  • Memory training
  • Daily exercise
  • Good nutrition/hydration
  • Keeping up with preventative care (Dunphy et al., 2019).

Labs/Diagnostics

• 
  CBC, CMP, serum Ca, TSH, FT4, Vitamin B12, UA, non-contrast CT brain (to rule out any surgically treatable lesions or vascular disease), PET scan (detect amyloid deposits) (Dunphy et al., 2019).

Referrals

• 
  Memory disorder center
  • Neurology for PET scan and evaluation
  • Social services (Dunphy et al., 2019).

Patient Education

• 
  Use memory aids and modify the environment at home so that her independent functioning can be maximized. By this I mean, declutter the house, make sure she uses proper footwear to avoid falls, keep important things she uses all the time out in the open where it can easily be found, etc. (Dunphy et al., 2019).
  • Stick to routine. The more familiar her day to day is, the longer her cognitive function will remain intact (Dunphy et al., 2019).
  • You can practice memory training to help with recall (Dunphy et al., 2019).
  • Exercise and enroll in recreation activities she would enjoy to help with socialization (Dunphy et al., 2019).
  • Have discussions about legal and financial issues related to decisions she is able to make and ones that should be left to someone she trusts, this includes end-of-life decisions (Dunphy et al., 2019).
  • Be sure to keep a closer eye on her; memory issues can be dangerous if she starts to wander and cannot remember where she is (Dunphy et al., 2019).
  • Donepezil (Aricept) common side effects are nausea, diarrhea, anorexia, and weight loss. We will monitor her liver function on this medication (Dunphy et al., 2019).
  • Donepezil does not prevent progression of AD, but can slow the rate of decline in cognitive function (Dunphy et al., 2019)