Initial History: Your patient is a 77 year-old woman who has been more socially
ID: 58058 • 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Your patient is a 77 year-old woman who has been more socially withdrawn lately and told her daughter she had not been feeling well.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.
ADDITIONAL HISTORY:
The daughter has noticed increased anxiety and confusion in her mother on several occasions
No personal or family history of psychological illness
Problems with abstract thinking
Poor or decreased judgment
Disorientation to time and place
Changes in mood and behavior
Changes in personality
FURTHER HISTORY:
No history of trauma or recent infection
Family history; father and brother have died from stroke and heart disease; mother had Alzheimer disease
Current medications: aspirin, 325 mg. daily; hydrochlorthiazide, 25 mg. bid
No other medical history
No known allergies
PHYSICAL EXAMINATION (Abnormal)
Alert, elderly woman in no acute distress
T = 37 C orally; P = 85 and regular, RR = 15 and unlabored; B/P 158/88 right arm (sitting)
Skin pale, dry with senile lentigines
Skin is transparent with decreased turgor
Minor multiple ecchymosis noted on both forearms, no other lesions or abrasions
Increased anterior/posterior diameter with mild kyphosis (lungs)
Orientation to time, person, and place are inconsistent—does not know the day or date
Gait slightly wide based and unable to tandem walk
Now what do you think about her history?
What studies would you initiate now while preparing for intervention?
What therapies would you initiate immediately while awaiting lab work?
Explanation / Answer
History of the patient reveals normal old age issues.
Since the mother of the patient had Alzhiemer disease, which is not genetically transmitted.; she might be suffering from the same disease now. Alzheimer disease is associated with reduced production of Acetyl CoA, and the history stated in the above question correlates with the symptoms of this old age disease. These include effective planning, changes in personality and loss of memory.
Therapies:-