What are several ways to distinguish depression from dementia?

Case Study Assignment for Unit VI: Neural Function and Disorders

Purpose: The purpose of this assignment is to encourage you to analyze pathophysiological processes and mechanisms of human disease, identify clinical signs and symptoms and diagnostic data consistent with the pathology of common health problems and determine appropriate medical treatment and nursing care based on best practices found in the literature. This assignment emphasizes critical thinking and problem-solving through the correlation of cellular and multi-system pathology with related assessment and diagnostic data, medical treatment and nursing management.

The answers to the questions should be complete and include professional literature to support each answer. You should include at least 3 current references (< 5 years old) of which 2 must be journal articles. References should include current nursing journals and other professional health related literature. The assignment should be uploaded electronically into blackboard under the appropriate assignment link.

The paper should be typed using APA format. APA format requires that you use correct grammar and spelling and double-space your entire paper. Use the questions as your headers. Please include the following rubric at the end of your paper.

The assignment will be graded using the following criteria:

Patient Case Analysis Assignment Grading Criteria	Possible Score	Earned Score
Answers to Questions 1. Demonstrates comprehensive critical analysis of pathology, assessment and diagnostic data, medical and nursing management (points accrued in case study)	30
Format 1. Answers are supported by references 1. Follows APA format	5 3 2
Total Score	35

Alzheimer’s Disease Case Study

Patient Profile and Background Information

RM is a 85-year-old woman who presents to the clinic with her two daughters for a routine exam. RM was diagnosed with Alzheimer’s disease nine years ago when she started to display short term memory loss. She was misplacing her glasses, keys, and placed some household items in illogical places. For example: she placed the coffee pot in the refrigerator. She also had taken some walks around her neighborhood where she has resided for over 45 years and had gotten lost on more than one occasion.

Her neighbors and family had also noticed that RM was becoming more quiet and passive. She was not as interested in participating in family outings or working in her garden, a past time she had enjoyed most of her adult life.

Physical Assessment and Diagnostic Data

A thorough workup with neuroimaging studies revealed no significant findings. However, she scored 25 out of a possible 30 points on the Mini-Mental Status exam. She was started on Aricept (donepezil) which helped with both her memory and mood for several years.

Four years ago, family members noticed another significant change in RM. Not only had previous manifestations become more severe, but she also began having difficulty with numbers, could no longer balance her check book. She could no longer play bridge and she showed signs of poor judgment by leaving her house without a coat in the middle of winter and going to the store in her nightgown. There was a small kitchen fire that occurred when she forgot to turn off the stove after cooking. Because of these new symptoms, RM was retested for new systemic disease processes but no significant abnormalities were detected other than a mild case of iron deficiency anemia. A CT scan of the brain revealed moderate to severe cerebral atrophy in the temporal and parietal lobes bilaterally. Her Mini Mental Status Examination (MMSE) score decreased to 18/30.

Question 1: What is the pathophysiology of Alzheimer’s Disease (AD)? (3 points)

Question 2: What risk factors does RM possess for developing AD? (2 points)

Question 3: Describe the MMSE, the categories and how each are tested. What does the score of 18 / 30 indicate? (4 points)

The daughters made the decision that RM could no longer live by herself and moved her into the oldest daughter’s home to live with her family. The two oldest daughters shared care giving responsibilities. Within the past six weeks, RM has begun to display multiple, sudden outbursts of anger. While shopping for groceries with her second daughter, she became separated and lost from her daughter and began throwing tomatoes at the store manager who was trying to help her. It took 15 minutes to calm her down. She also began having occasional urinary accidents. The daughters’ state that caring for their mother in now becoming unmanageable and are considering seeking a long-term care facility for her.

RM’s PMH consists of long standing hypertension for 30 years. Hypercholesterolemia for 25 years.

Family history: both parents deceased. Father died at 70 from a CVA. Mother died from AD at the age of 80. One brother died at the age of 65 from an MI. She has a sister who died of AD five years ago at the age of 76.

Social History: Widowed for 14 years after 55 years of marriage. Does not smoke or drink alcohol. Her regular medications include:

Aricept (donepezil)

Avapro (irbesartan)

Crestor (rosuvastatin)

One baby aspirin daily

Question 4: Describe the mechanism of action of each of the above medications, and why RM is taking them. (4 points)

Question 5: What diagnostics tests would you anticipate being ordered to evaluate RM’s health status and why? (3 points)

Question 6: Vascular dementia must be considered as a possible cause of RM’s increasing cognitive dysfunction. Explain the pathophysiology of vascular dementia and the risk factors associated with it. (4 points)

Question 7: Depression in an elderly patient is often mistaken for AD. What are several ways to distinguish depression from dementia? (2 points)

Question 8: Discuss the 3 stages of AD with the common symptoms associated with each stage. (6 points)

Question 9: What needs do you anticipate for the family? What are some key teaching points for the family regarding RM’s care? (2 points).