Initial History: Your patient is a 77 year-old woman who has been more socially
ID: 56956 • Letter: I
Question
Initial History:
Your patient is a 77 year-old woman who has been more socially withdrawn lately and told her daughter she had not been feeling well. While shopping for groceries with her daughter she became separated from daughter in the aisles. She became confused and angry when store employees and others tried to assist her. It is now 30 minutes later.
Discussion questions part one:
What is your differential diagnosis based on the information you now have?
What other questions would you like to ask her now? (Questions can be asked of patient first, and then of reliable historian separately.)
Explanation / Answer
Late stage of Alzheimer's dementia
Diagnosis:
1. Age
When people age 65 and older, Alzheimer's dementia is the most common cause of dementia. The age of patient in our study is 77 years.
2. Withdrawal from work or social activities
People may have trouble keeping up and avoid being social because of the changes they have experienced. In this case the patient has withdrawn socially and not feeling well.
3. Decreased or poor judgment and Changes in mood and personality:
People with Alzheimer's may experience changes in judgment or decision-making. The mood and personalities of people with Alzheimer's can change. They can become confused, suspicious, depressed, fearful or anxious. In this case, the patient became confused and angry when store employees and others tried to assist her.
4. Memory loss for recent activities
Individuals may have an especially hard time remembering newly learned information and repeatedly ask the same question. In this case patient is not able to recall like her daughter or the events which brought her to this place even after 30 minutes
5. Decline in physical abilities
A person may become unable to walk without assistance, then unable to sit or hold up his or her head without support. In our case the patient was assisted.
6. Require daily assistance with personal care
This includes total assistance with eating, dressing, using the bathroom and all other daily self-care tasks. In this study the patient is being assisted by her daughter for grocery shopping.
Questionnaire for girl assisting patient (old woman 77 years old)
For memory
a. Does your mother have memory loss which has worsened over a few years ago?
b. Does your mother repeat questions, statements, or stories in the same day?
c. Does your mother misplace items and suspect others of hiding or stealing items?
Language
a. Does your mother have trouble finding words other than names?
b. Does your mother have trouble recognizing familiar people?
c. Does your mother confuse names of family members or friends?
Functional Ability
a. Does your mother have trouble handling money or paying bills or doing finances?
b. Does your mother have trouble remembering to take medicines or tracking medications taken?
c. Is your mother having trouble using applicances?
d. Does your mother have difficulty completing home repair or other home-related tasks, such as housekeeping?
e. Has your mother given up or significantly cut back on hobbies such as golf, dancing, exercise, or crafts?
Orientation
a. Does your mother become disoriented in unfamiliar places?
b. Does your mother become more confused outside the home or when traveling?
Visuospatial Ability
a. Does your mother get lost in familiar surroundings, such as their own neighborhood?
b. Does she have a decreased sense of direction?