Respond to the 2 following discussion posts separately with separate reference lists. References to be no older than 5 years.
1. Hanah Lee Yee posted Oct 18, 2022 1:14 PM
Alzheimer’s is a progressive illness starting with a mild short memory and possibly resulting in loss of the capability to talk and react to the environment. To diagnose Alzheimer’s disease, physicians perform tests to evaluate memory impairment as well as different thinking skills, judge operative capabilities, and establish attitude transformations (Zhao et al., 2018). They still do a series of tests to establish other potential triggers of impairment.
To assess the 72-year-old, I will do brain scans, consisting of “computed tomography (CT), magnetic resonance imaging (MRI)”, or “positron emission tomography (PET)”, to back an Alzheimer’s judgment or determine other potential triggers for signs (Zhao et al., 2018). I will also order urine, blood, and different standard clinical tests that may assist find other potential causes of the issue. The tests may still assist diagnose different causes of memory, consisting of tumors, stroke Parkinson’s disease, sleep distractions, side effects of treatments, an infection, or other types of dementia (Zhao et al., 2018).
Differential Diagnoses
The three differential diagnoses include frontotemporal dementia (FTD), depression, and Vascular Dementia (VaD).
Frontotemporal dementia is a rare form of dementia that triggers issues with attitude as well as language (Kuring et al., 2020). Dementia is the title for issues with psychological capabilities triggered by slow transformations and harm in the cerebrum. Frontotemporal dementia impacts the sides and front of the cerebrum also known as the frontal and temporal lobes. This kind of illness is triggered by clumps of unusual protein forming inside the mind cells. This abnormal protein is thought to destroy the cells and prevent them from functioning appropriately. Mainly, the proteins build up in the temporal and frontal lobes of the cerebrum at the front and sides.
Professionals state that people with Alzheimer’s disease also suffer from considerable depression (Kuring et al., 2020). Depression refers to a mood condition that triggers a persistent feeling of loss of interest as well as sadness. Still referred to as “major depressive disorder” or medical depression, depression, impacts the way an individual feels, thinks, and behaves and may result in various mental and physical issues. Establishing depression in an individual suffering from Alzheimer’s can be challenging because dementia may trigger some similar symptoms. Some of the symptoms that are similar to both dementia and depression include Apathy.
Vascular dementia (VaD) is known to be the second-most-usual trigger of dementia in the elderly, after Alzheimer’s disease (AD) (Morton et al., 2019). Vascular dementia (VaD) is largely described as dementia, classified by minimized memory and function loss. This form of illness is commonly triggered by conditions that happen most frequently in older individuals, consisting of atherosclerosis or hardening of the arteries, cardiac disease, as well as stroke. The number of individuals above 65 years is maximizing because individuals are living longer with serious diseases like diabetes and heart disease (Morton et al., 2019). Vascular illness and Alzheimer’s disease usually happen together. Studies indicate that several people with dementia as well as evidence of brain vascular illness still have Alzheimer’s disease.
Initial Treatment Plan
My initial treatment plan will involve prescribing Donepezil, rivastigmine, and galantamine, coping strategies, mental stimulation therapy, and mental rehabilitation. Cognitive rehab engages mental rehabilitation works by getting one to utilize the parts of the mind that are functioning to assist the parts that are not working. “Cognitive stimulation therapy (CST)” engages in taking part in team pursuits and practices to enhance memory and issue-solving skills. “Cholinesterase inhibitors (ChEIs), donepezil, rivastigmine, and galantamine slow down the digestion of acetylcholine delivered to synaptic clefts and as such improves cholinergic neurotransmission (Haake et al., 2020). The three medications are effective in treating mild to moderate Alzheimer’s illness.
References
Haake, A., Nguyen, K., Friedman, L., Chakkamparambil, B., & Grossberg, G. T. (2020). An update on the utility and safety of cholinesterase inhibitors for the treatment of Alzheimer’s disease. Expert opinion on drug safety, 19(2), 147-157.
https://www.tandfonline.com/doi/abs/10.1080/14740338.2020.1721456
Kuring, J. K., Mathias, J. L., & Ward, L. (2020). Risk of Dementia in persons who have previously experienced clinically-significant Depression, Anxiety, or PTSD: A Systematic Review and Meta-Analysis. Journal of Affective Disorders, 274, 247-261.https://www.sciencedirect.com/science/article/abs/pii/S0165032719323031
Morton, R. E., St. John, P. D., & Tyas, S. L. (2019). Migraine and the risk of all‐cause dementia, Alzheimer’s disease, and vascular dementia: A prospective cohort study in community‐dwelling older adults. International journal of geriatric psychiatry, 34(11), 1667-1676. https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.5180
Zhao, J., Chen, J., Ma, S., Liu, Q., Huang, L., Chen, X., … & Wang, W. (2018). Recent developments in multimodality fluorescence imaging probes. Acta Pharmaceutica Sinica B, 8(3), 320-338. https://www.sciencedirect.com/science/article/pii/S2211383517306809
2. Week Eight
Contains unread posts
John Beighle posted Oct 19, 2022 6:51 PM
First, we should visit with the daughter and see her rationale for wanting to have her mother tested for Alzheimer’s. Then the APRN provider should review past medical records, current medication, and the most recent clinic visits history and gathers as much information about the patient as possible, including questioning the daughter in the discovery process. Secondly, we need to look at her living situation, caregivers versus autonomy, diet and meal preparation, and current alcohol or drug usage, and see if she is getting daily exercise. I would perform a questionnaire screening tool for cognitive impairment, such as the Mini-Mental Screening Exam MMSE, Memory Alteration Test, or other screening exams, to place a relative score on the questions answered during these screening tests (Breton et al., 2019). To check for mobility and stability, I would incorporate the Timed Up & Go Test to observe balance, mobility, and motor function (Nightingale et al., 2019). Based on the complete review of the patient, mental status exam, and cognitive testing, we would be able to narrow the differential diagnosis to include dementia, Alzheimer’s, and vascular dementia (Avranitakis et al., 2019).
The top three differential diagnoses should be dementia caused by Parkinson’s disease, ICD – G20, Lewy-body dementia ICD – G31.83 and Alzheimer’s Disease, ICD – G30.9. Astute clinicians should always investigate for other causes of changes in mentation and physical mobility, including cerebrovascular and neurological injury (Avranitakis et al., 2019).
Treatment should always include basic labs such as TSH, B12, CMP, and CBC, along with a non-contrast CT of the brain to rule in or out focal defects in the brain. Investigating brain injury can go a long way in getting the diagnosis right, indicating cerebral or neurological causes versus seeing parkinsonian symptoms in the patient, such as cogwheel rigidity and wide shuffling gait indicating Parkinson’s disease. Treatment should include both cognitive engagement activities and pharmacological prescribing when symptoms warrant the need for medical management. Engagement activities may include all brain stimulation activities such as conversation, paying bills, shopping, and games that involve thinking and concentration. The pharmacological intervention will include anticholinesterase inhibitors such as Donepezil 5 mg at bedtime or Memantine 5 mg orally; these medications may slow down the changes in cognitive memory defects but will not alter the course of the disease (Grossberg et al., 2019).
References
Arvanitakis, Z., Shah, R. C., & Bennett, D. A. (2019). Diagnosis and Management of Dementia: Review. JAMA, 322(16), 1589–1599. https://doi.org/10.1001/jama.2019.4782
Breton, A., Casey, D., & Arnaoutoglou, N. A. (2019). Cognitive tests for the detection of mild cognitive impairment (MCI), the prodromal stage of dementia: Meta-analysis of diagnostic accuracy studies. International journal of geriatric psychiatry, 34(2), 233–242. https://doi.org/10.1002/gps.5016
Grossberg, G. T., Tong, G., Burke, A. D., & Tariot, P. N. (2019). Present Algorithms and Future Treatments for Alzheimer’s Disease. Journal of Alzheimer’s disease : JAD, 67(4), 1157–1171. https://doi.org/10.3233/JAD-180903
Nightingale, C. J., Mitchell, S. N., & Butterfield, S. A. (2019). Validation of the Timed Up and Go Test for Assessing Balance Variables in Adults Aged 65 and Older. Journal of aging and physical activity, 27(2), 230–233. https://doi.org/10.1123/japa.2018-0049
