Reference no: EM133578387

Assignment:

Patient Initial Complaint: The patient is referred to your office by her PCB at the age of 58 with a 2-year history of repetitiveness, memory loss, and executive function loss. Magnetic resonance imaging scan at age 58 revealed mild generalized cortical atrophy. She is white with 2 years of post secondary education. Retirement at age 48 from employment as a manager in telecommunications company was because family finances allowed and not because of cognitive challenges with work. Progressive cognitive decline was evident by the report of deficits in instrumental activities of daily living performance over the past 9 months before her initial consultation in the memory clinic. Word finding and literacy skills were noted to have deteriorated in the preceding 6 months according to her spouse. Examples of functional losses were being slower in processing and carrying out instructions, not knowing how to turn off the stove, and becoming unable to assist in boat docking which was the couple's pastime.

She stopped driving a motor vehicle about 6 months before her memory clinic consultation. Her past medical history was relevant for hypercholesterolemia and vitamin D deficiency. She had no surgical history. She had no history of smoking, alcohol, or other drug misuse. Laboratory screening was normal. There was no first-degree family history of presenile dementia. Neurocognitive assessment at the first clinic visit revealed a Mini Mental State Examination (MMSE) score of 14/30; poor verbal fluency (patient was able to produce only 5 animal names and 1 F-word in 1 min) as well as poor visuospatial and executive skills (Fig. 1). She had fluent speech without semantic deficits. Her neurological examination was pertinent for normal muscle tone and power, mild ideomotor apraxia on performing commands for motor tasks with no suggestion of cerebellar dysfunction, normal gait, no frontal release signs. She had normal hearing. There was no evidence of depression or psychotic symptoms.

Social History: Patient lives with husband. Four children are grown and live nearby.

Vital Signs: BP 142/88; PR 76; O2 Sats 98 on RA; RR 13; Ht 61"; and Wt 145lbs.

Questions:

1. What is the purpose of the MMSE and what does her score of 19/30 represent?
2. What medications will you prescribe for this patient, if any?
3. If the MMSE score was 11/30, will that change your medication recommendation?
4. Suppose the patient's husband also states that the patient has become sexually hyperactive, and often performs risque acts in public that are "completely not like her". What type of dementia may the patient be experiencing in addition to Alzheimer's?
5. What environmental changes to the patient's living situations will you recommend to assist her in coping with the disorder?
6. Suppose the patient becomes very agitated, and starts to pose a small threat to herself or others. Will you medicate the patient? If so, what will you prescribe?