Peer Responses:
- Length: A minimum of 180 words per post, not including references
- Citations: At least two high-level scholarly reference in APA per post from within the last 5 years
- Relate to another journal reading
A 72-year-old female patient who’s daughter report decline in patient’s memory and physical mobility over the past year presents for annual wellness exam. I would assess this patient by first eliminating any diagnosis that could be life threatening such as stroke symptoms. Assessment criteria would be to establish patient stability with vital signs and a neurological exam (Caplan, 2024). As long as the patient is stable, ongoing exam with history taking and a physical exam would take place next. The clinical interview is the key to evaluating someone with memory loss (Petersen, 2024). Medical and neurological history, medication list, sleep history, and psychiatric conditions should be discussed and evaluated for the cause of symptoms. Motor symptoms to assess for would be tremor, rigidity, and bradykinesia with gait or balance disturbance (Pringsheim et al., 2021).
Dementia is a considered diagnosis due to information provided with the decline in cognition (Larson, 2024). Alzheimer’s disease is the most common form of dementia in older adults. Criteria for diagnosis requires more information. Cardinal symptoms of Alzheimer disease are memory impairment and motor signs (Wolk & Dickerson, 2024) both of which this 72-year-old patient has. When performing the patient assessment and interview, impairment of learning and memory, language, executive function, complex attention, perceptual-motor function or social cognition must show significant cognitive impairment. The impairment must interfere with everyday activities, not be exclusive to delirium, and not related to another mental disorder. Stroke diagnosis is considered but less likely due to onset of symptoms noticed by daughter over time. Thrombosis-related stroke symptoms can fluctuate with periods of improvement (Caplan, 2024). Imaging evaluation will demonstrate further information for official diagnosis. The third considered diagnosis is Parkinson disease. Parkinson disease is a complex movement disorder that can have non-motor symptoms such as cognitive dysfunction (Chou, 2024).
The initial treatment plan would be ruling out any other causes for the patient’s symptoms. Laboratory testing for B12 deficiency, complete blood count, and thyroid stimulating hormone if suspected (Larson, 2024). The patient should be also screened for depression. Imaging is more indicate with acute symptoms. The 72-year-old patient does not need immediate imaging of the brain but MRI and CT scan can be ordered due to atypical findings on exam. The patient may need specialized testing by a neurologist or geriatrician which would require a referral from the primary care provider.
Reference:
Caplan, L. R. (2024). Overview of the evaluation of stroke. UpToDate. Retrieved on April 15, 2024 from https://www.uptodate.com/contents/overview-of-the-evaluation-of-stroke
Chou, K. L. (2024). Clinical manifestations of Parkinson disease. UpToDate.Retrieved on April 17, 2024 from https://www.uptodate.com/contents/clinical-manifestations-of-parkinson-disease?search=parkinsons
Larson, E. B. (2024). Evaluation of cognitive impairment and dementia. UpToDate. Retrieved on April 15, 2024 from https://www.uptodate.com/contents/evaluation-of-cognitive-impairment-and-dementia
Petersen, R. C. (2024). Mild cognitive impairment: Epidemiology, pathology, and clinical assessment. UpToDate.Retrieved on April 15, 2024 from https://www.uptodate.com/contents/mild-cognitive-impairment-epidemiology-pathology-and-clinical-assessment
Pringsheim, T., Day, G. S., Smith, D. B., Rae-Grant, A., Licking, N., Armstrong, M. J., de Bie, R., Roze, E., Miyasaki, J. M., Hauser, R. A., Espay, A. J., Martello, J. P., Gurwell, J. A., Billinghurst, L., Sullivan, K., Fitts, M. S., Cothros, N., Hall, D. A., Rafferty, M., Hagerbrant, L., Hastings, T., O’Brien, M. D., Silsbee, H., Gronseth, G., & Lang, A. E. (2021). Dopaminergic therapy for motor symptoms in early Parkinson disease practice guideline summary. Neurology Journals 97(20). https://www.neurology.org/doi/10.1212/WNL.0000000000012868
Wolk, D. A. & Dickerson, B. C. (2024). Clinical features and diagnosis of Alzheimer disease. UpToDate. Retrieved on April 17, 2024 from https://www.uptodate.com/contents/clinical-features-and-diagnosis-of-alzheimer-disease
