Neurocognitive Case Study – Patient with Alzheimer’s Disease (AD)

Neurocognitive Case Study – Patient with Alzheimer’s Disease (AD)

The case presented is of a 75-year-old male presenting with complaints of forgetfulness, difficulty completing familiar tasks, and recent episodes of getting lost while driving in familiar areas.  The symptoms began two years ago.  The suspected neurocognitive disorder is a Major neurocognitive disorder due to possible Alzheimer’s disease (AD), without behavioral disturbances.

Description of AD

Alzheimer’s disease is a progressive neurodegenerative disorder characterized by significant impairments in the cognitive functioning and behavior of an individual. These functions include language, memory, reasoning, comprehension, and judgment. The manifestations of AD vary with the stage. Episodic short-term memory is an early and the most common disease symptom. As the disease progresses, language impairment and neuropsychiatric symptoms such as social withdrawal, psychosis, social withdrawal, and wandering also appear. Dyspraxia, sleep disturbances, incontinence, and extrapyramidal side effects such as dystonia characterize late-stage AD (Breijyeh & Karaman, 2020).

Neuroanatomy of AD

The pathophysiological principles underlining AD development are the loss of neurons in the neocortex and the basal forebrain (Breijyeh & Karaman, 2020). In normal individuals, the amyloid precursor proteins are cleaved by secretase enzymes to form tiny fragments that are safe for the neurons. In the pathogenesis of AD, sequential cleavage of the amyloid precursor proteins by the beta and then gamma secretases results in abnormal beta amyloid proteins. Accumulation of the beta-amyloid proteins in specific regions of the brain involved in memory functionalities causes neuronal toxicity with consequent manifestations of AD symptoms. As the levels of the abnormal beta-amyloid proteins approach the tipping point, aggregation of fibrillary amyloid proteins is favored over normal amyloid, causing disease progression (Breijyeh & Karaman, 2020).

Physiological and Mental Status Exam Findings in AD

AD is a progressive neurodegenerative disorder. The physiological and mental status exam findings often correspond with the stage of the disorders. In the early stage, memory loss is the predominant manifestation. Patients at this stage usually present with episodic short-term memory, with preserved long-term memory. The mental status exam will reveal impairment in short-term memory, and organizational skills impairment.  Loss of instrumental activities of daily living may also be apparent in the early stage (Abubakar et al., 2022). As the disease progresses, language disorders and impairments in visuospatial skills appear. Neuropsychiatric symptoms such as apathy, disinhibition, psychosis, and social withdrawal begin to manifest in the later stages of the disease. Physiological findings in these later stages include loss of language, difficulty locating items, poor navigation and subsequent wandering, and poor conceptualization of distance, among others. In the late phase of the disease, dyspraxia, loss of primitive reflexes, extrapyramidal side effects, olfactory dysfunction, and sleep disturbances appear. Physiological findings in patients with end-stage AD include sleep disturbances, incontinence, difficulty performing learned motor tasks, dystonia, akathisia, and anosmia. Mental status exam reveals memory loss, unresponsiveness, poor orientation, poor judgment and problem-solving, and speech impairments (Abubakar et al., 2022).

Cultural, Spiritual, and Biopsychosocial Factors to Consider for AD

AD is a progressive psychiatric disorder. A cultural consideration to make when diagnosing and managing AD is the perception of the disease across cultures. Rosselli et al. (2022) note that some cultures view AD as a normal part of aging and may not give it the medical considerations it requires. Likewise, stigma is another challenge when managing this disorder. Lack of awareness of AD, coupled with shame and guilt about the disease and other mental health conditions, may impact treatment. Additionally, spirituality plays a role in the management of AD. In the later stages of the disease, prayers and meditation help preserve a sense of meaning and hope among patients with AD. A biopsychosocial factor to consider in AD is the role of the family in managing the disease. Family is an important aspect of well-being that inspires hope in patients with AD. It is thus important that caregivers for patients with AD allow the patients’ families to be involved in their care processes.

Diagnostic Testing

AD diagnosis is arrived at after a comprehensive subjective, physical, and mental status examination. The Diagnostic and Statistical Manual for Mental Health Disorders (DSM) outlines the diagnostic criteria for AD. As per these criteria, a positive diagnosis of AD is made in the presence of a decline in memory and learning and at least one of the other cognitive domains and interference with ADLs (DSM-V, 2018). Screening tools such as the Montreal Cognitive Assessment Exam (MOCA) are effective in determining cognitive decline and can aid in the diagnosis.

Diagnosis

Primary Diagnosis

The presumptive diagnosis is Alzheimer’s disease (AD) (G30.9). AD is a neurodegenerative disorder characterized by functional and cognitive decline. Persons with the disorders will commonly manifest with memory loss, difficulty recalling events, increased reliance on task organizers, repeating themselves in conversations, and difficulties in recall (DSM-V, 2018). The patients in the case presented with short-term memory loss, difficulty completing familiar tasks, and getting lost while driving in familiar places. Assessment findings revealed that he repeated himself during conversations, had difficulty in activities of daily living such as driving and cooking, and needed reminders for medications. These manifestations are consistent with those of early-stage Alzheimer’s disease, warranting the diagnosis.

Differential Diagnosis

Lewy Body Dementia (DLB) G31.83

Lewy Body dementia is characterized by dementia, psychosis, and features of Parkinsonism. The neuroanatomy of Lewy body dementia reveals acetylcholine deficiency in the substantia nigra, locus ceruleus, dorsal motor nucleus of the vagus nerve, and dorsal raphe (Menšíková et al., 2022). Physiological findings in the disease include loss in executive functioning, muscle rigidity, tremors, sleep disturbance, and bradykinesia. Memory loss is apparent in the later stages of the disease (Menšíková et al., 2022). Psychiatric findings include hallucinations and delusions. Poor perception and subsequent stigma are a cultural consideration for the disorder. Prayer and medications are the likely spiritual considerations for the disorders, as patients tend to find hope from spirituality during the later stages of the disorder. Family is a biopsychosocial consideration for DLB, as the family is a source of psychosocial support for patients diagnosed with the disorder. LBD is a progressive disorder with a fair to poor prognosis. The average life expectancy is between five to eight years after the initial diagnosis.

Frontotemporal Dementia (FTD) G31.0

This is another possible differential. It is characterized by a loss of intellectual functions. Neuroanatomical analysis reveals that the disease affects the frontal and temporal lobe and is a consequence of the deposition of abnormal protein aggregates (Antonioni et al., 2023). Physiological assessment findings in FTD include disinhibition, loss of executive functioning, memory loss in late-stage disease, and loss of fundamental emotions.  Psychiatric findings include impaired comprehension, incoherent speech, and compulsive behaviors (Antonioni et al., 2023).  Poor perceptions and subsequent stigma are a cultural consideration for the disorder. Prayer and meditation are the likely spiritual considerations for the disorders, as patients tend to find hope from spirituality during the later stages of the disorder. Family is a biopsychosocial consideration for FTD, as family is a source of psychosocial support for patients diagnosed with the disorder. FTD is a progressive disorder with a fair to poor prognosis. The average life expectancy is 7.5 years after the initial diagnosis.

Anticipated Prognosis of AD

AD is a progressive neurodegenerative disorder. The disease has a fair to poor prognosis as it has no cure. Individuals aged 65 and above diagnosed with the disease may have a life expectancy of up to eight years. However, the prognosis is fair, with a life expectancy of up to 20 years, if the disease is detected early and the affected individuals are started on medications.

References

Abubakar, M. B., Sanusi, K. O., Ugusman, A., Mohamed, W., Kamal, H., Ibrahim, N. H., Khoo, C. S., & Kumar, J. (2022). Alzheimer’s disease: An update and insights into pathophysiology. Frontiers in Aging Neuroscience, 14. https://doi.org/10.3389/fnagi.2022.742408

Antonioni, A., Raho, E. M., Lopriore, P., Pace, A. P., Latino, R. R., Assogna, M., Mancuso, M., Gragnaniello, D., Granieri, E., Pugliatti, M., Di Lorenzo, F., & Koch, G. (2023). Frontotemporal dementia, where do we stand? A narrative review. International Journal of Molecular Sciences, 24(14), 11732. https://doi.org/10.3390/ijms241411732

Breijyeh, Z., & Karaman, R. (2020). A comprehensive review on Alzheimer’s disease: Causes and treatment. Molecules, 25(24), 5789. https://doi.org/10.3390/molecules25245789

DSM-V. (2018). Diagnostic and Statistical Manual. Google Docs.

Menšíková, K., Matěj, R., Colosimo, C., Rosales, R., Tučková, L., Ehrmann, J., Hraboš, D., Kolaříková, K., Vodička, R., Vrtěl, R., Procházka, M., Nevrlý, M., Kaiserová, M., Kurčová, S., Otruba, P., & Kaňovský, P. (2022). Lewy body disease or diseases with Lewy bodies? Npj Parkinson’s Disease, 8(1). https://doi.org/10.1038/s41531-021-00273-9

Rosselli, M., Uribe, I. V., Ahne, E., & Shihadeh, L. (2022). Culture, ethnicity, and level of education in Alzheimer’s disease. Neurotherapeutics, 19(1), 26–54. https://doi.org/10.1007/s13311-022-01193-z

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Purpose

This assignment allows students to evaluate, contrast, research, and present the neurocognitive disorder assigned to them. The student will be assigned one of the available case studies from this assignment at the beginning of the course. The student will evaluate the case study to determine the diagnosis for the client. Based on the client’s diagnosis, the student will explore the neuroanatomy, physiological examination, mental status examination, clinical presentation, differential diagnosis, and treatment of the assigned topic. This paper is broken down into sections each week, ending with a presentation in week three of the course.

Neurocognitive Case Study – Patient with Alzheimer’s Disease (AD)

Part One – Module One

• The student will work individually on the
• The entire paper is completed on the case study assigned to the student at the beginning of the course.
• Part one of the paper should be three to five pages long (not including title/reference pages), using the current APA formatting requirements with appropriate grammar and The paper requires at least four peer-reviewed resources, one of which may be the DSM-V-TR. All peer- reviewed resources used in the paper should be less than five years old.
• Part One of the paper must include:
• Title page in APA format
• Brief opening description of the neurocognitive disorder suspected
• Neuroanatomy of the neurocognitive disorder
• Physiological and mental status examination assessment findings for the neurocognitive disorder
• Cultural, spiritual, and biopsychosocial factors to consider for the neurocognitive disorder
• Diagnostic testing recommended for the neurocognitive disorder, including screening tools
• Formulation of the primary diagnosis for the client with two differential The student must provide detailed information that supports the primary diagnosis and a rationale for each of the two differential diagnoses, contrasting the features of these disorders with those of the primary diagnosis.
  • When comparing and contrasting your differential diagnoses, make sure to address the following components for each:
    • neuroanatomy
    • physiological assessment findings
    • psychiatric assessment findings
    • cultural considerations
    • spiritual considerations
    • bio-psychosocial considerations
    • disorder prognosis
  • Anticipated prognosis for the client
  • Reference page with all references in APA format