A 72-year-old man, K.B., is brought to the emergency department by his daughter for progressively worsening cognitive issues over the past year including memory problems, disorientation, depression, and behavioral changes. His medical history includes heart disease. Diagnostic tests show he has Alzheimer's dementia. He is prescribed the medication donepezil but his daughter calls back concerned it is not working as she hoped to cure his condition.
A 72-year-old man, K.B., is brought to the emergency department by his daughter for progressively worsening cognitive issues over the past year including memory problems, disorientation, depression, and behavioral changes. His medical history includes heart disease. Diagnostic tests show he has Alzheimer's dementia. He is prescribed the medication donepezil but his daughter calls back concerned it is not working as she hoped to cure his condition.
A 72-year-old man, K.B., is brought to the emergency department by his daughter for progressively worsening cognitive issues over the past year including memory problems, disorientation, depression, and behavioral changes. His medical history includes heart disease. Diagnostic tests show he has Alzheimer's dementia. He is prescribed the medication donepezil but his daughter calls back concerned it is not working as she hoped to cure his condition.
A 72-year-old man, K.B., is brought to the emergency department by his daughter for progressively worsening cognitive issues over the past year including memory problems, disorientation, depression, and behavioral changes. His medical history includes heart disease. Diagnostic tests show he has Alzheimer's dementia. He is prescribed the medication donepezil but his daughter calls back concerned it is not working as she hoped to cure his condition.
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CASE #1
You are the nurse working triage in the emergency department.
This afternoon, a woman brings in her father, K.B., who is 72 years old. The daughter reports that, over the past year, she has noticed her father has progressively had problems with his mental capacity. These changes have developed gradually but seem to be getting worse. At times he is alert, and at other times he seems disoriented, depressed, and tearful. He is forgetting things and doing things out of the ordinary, such as placing the milk in the cupboard and sugar in the refrigerator.
This morning, he thought it was nighttime and wondered what his daughter was doing at his house. He could not pour his own coffee, and he seems to be getting more agitated. K.B. reports that he has been having memory problems for the past year and, at times, has difficulty remembering the names of family members and friends. His neighbor found him down the street 2 days ago, and K.B. did not know where he was.
A review of his past medical history is significant for hypercholesterolemia and coronary artery disease. He had a myocardial infarction 5 years ago. K.B.'s vital signs today are all within normal limits.
1. What are some cognitive changes seen in a number of elderly patients?
2. You know that physiologic age-related changes in the elderly can influence cognitive functioning. Name and discuss one.
3. For each behavior listed, specify whether it is associated with delirium (DL) or dementia (DM). a. Gradual and insidious onset b. Hallucinations or delusions c. A sudden, acute onset of symptoms d. The functional impairment is progressive. e. Inability to perform ADLs f. Incoherent interactions with others g. Patients may demonstrate wandering behavior. h. Behavior disorders often worsen at night.
4. Based upon the information provided by the daughter, do you think K.B. is showing signs of delirium or dementia? Explain.
5. You know that there are four main types of dementia that result in cognitive changes. List two of these types of dementia.
6. How can the level or degree of the dementia impairment be determined?
7. A number of diagnostic tests have been ordered for K.B. From the tests listed, which would be used to diagnose dementia? Mental status examinations Toxicology screen Mini-Mental State Examination ECG EEG CMP CBC with differential Thyroid function tests Colonoscopy RPR Serum B12 Bleeding time HIV screening CT MRI
After reviewing K.B.'s history and diagnostic test results, K.B. was diagnosed with Alzheimer's dementia. The physician calls a family conference to discuss the implications with K.B. and his daughter.
8. What neuroanatomic changes are seen in individuals with Alzheimer's disease?
9. List at least three interventions you would plan for K.B.
K.B. is discharged and sees his primary care physician 2 days later. K.B. receives a prescription for donepezil (Aricept) 5 mg PO/day at night. As you review the prescription with K.B.'s daughter, she tells you that she is “excited” because she did not know there were medications that could cure Alzheimer's disease.
10. How do you respond?
Two weeks later, K.B.'s daughter calls the physician's office and states, “I realize that the Aricept will not cure my dad, but there has been no improvement at all. Are we wasting our money?”
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