Case Study: ALZHEIMER’S TYPE DEMENTIA
Requirements
Read the case study below and answer the questions related to the case scenario and support your response with at least one evidence-based reference. You must use at least one scholarly reference to provide pathophysiology statements. Use of the McCance textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal.
CASE SCENARIO
A 76-year -old man is brought to the primary care office by his wife with concerns about his worsening memory. He is a retired lawyer who has recently been getting lost in the neighborhood where he has lived for 35 years. He was recently found wandering and has often been brought home by neighbors. When asked about this, he becomes angry and defensive and states that he was just trying to go to the store and get some bread.
His wife expressed concerns about his ability to make decisions as she came home two days ago to find that he allowed an unknown individual into the home to convince him to buy a home security system which they already have. He has also had trouble dressing himself and balancing his checkbook. At this point, she is considering hiring a day-time caregiver help him with dressing, meals and general supervision while she is at work.
Past Medical History: Gastroesophageal reflux (treated with diet); is negative for hypertension, hyperlipidemia, stroke or head injury or depression
Allergies: No known allergies
Medications: None
Family History
•    Father deceased at age 78 of decline related to Alzheimer’s disease
•    Mother deceased at age 80 of natural causes 
•    No siblings
Social History
•    Denies smoking
•    Denies alcohol or recreational drug use 
•    Retired lawyer
•    Hobby: Golf at least twice a week
Review of Systems
•    Constitutional: Denies fatigue or insomnia
•    HEENT: Denies nasal congestion, rhinorrhea or sore throat.  
•    Chest: Denies dyspnea or coughing
•    Heart: Denies chest pain, chest pressure or palpitations.
•    Lymph: Denies lymph node swelling.
•    Musculoskeletal: denies falls or loss of balance; denies joint pain or swelling
General Physical Exam  
•    Constitutional: Alert, angry but cooperative
•    Vital Signs: BP-128/72, T-98.6 F, P-76, RR-20
•    Wt. 178 lbs., Ht. 6’0″, BMI 24.1
HEENT
•    Head normocephalic; Pupils equal and reactive to light bilaterally; EOM’s intact
Neck/Lymph Nodes
•    No abnormalities noted  
Lungs 
•    Bilateral breath sounds clear throughout lung fields.
Heart 
•    S1 and S2 regular rate and rhythm, no rubs or murmurs. 
Integumentary System 
•    Warm, dry and intact. Nail beds pink without clubbing.  
Neurological
•    Deep tendon reflexes (DTRs): 2/2; muscle tone and strength 5/5; no gait abnormalities; sensation intact bilaterally; no aphasia
Diagnostics
•    Mini-Mental State Examination (MMSE): Baseline score 12 out of 30 (moderate dementia)
•    MRI: hippocampal atrophy
•    Based on the clinical presentation and diagnostic findings, the patient is diagnosed with Alzheimer’s type dementia.
CASE STUDY QUESTIONS
1.    Compare and contrast the pathophysiology between Alzheimer’s disease and frontotemporal dementia.
2.    Identify the clinical findings from the case that supports a diagnosis of Alzheimer’s disease.  
3.    Explain one hypothesis that explains the development of Alzheimer’s disease
4.    Discuss the patient’s likely stage of Alzheimer’s disease.
*Scholarly source: U.S. based peer reviewed journals geared for clinicians (MD/DO/NP/PA) published in the past five years or the latest edition of a clinical practice guideline. All scholarly, peer-reviewed research articles must be current – within a 5-year time frame.
Reference
McCance, K.L. & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier Health Sciences.
•    Chapter 16: Pain, temperature regulation, sleep and sensory function, pp.485-486
•    Chapter 17: Alterations in cognitive systems, cerebral hemodynamics, and motor function, pp. 518-524, 536-538
•    Chapter 18: Disorders of the central and peripheral nervous systems and the neuromuscular junction, pp.581 -583, 583-585
•    (Chapter 15: Structure and function of the neurologic system)