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Psychiatric Disorder: Dementia
Psychiatric Disorders Case Study 141
Ifeoma C. Anene
California Baptist University
Case Study 141: DEMENTIA
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Psychiatric Disorder: Dementia
►SCENARIO O
You are the nurse working triage in the ED. 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 two 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 five years ago. K.B.’s vital signs are all within
normal limits.
1. What are some cognitive changes seen in a number of elderly patients?
A degree of cognitive degeneration in all aged humans, which will include the following:
Loss of immediate memory and associated benign amnesia
Worsened presentation on intricate learning tasks
Decelerating of the thought processes
2. You know that physiologic age-related changes in the elderly can influence cognitive
functioning. Name and discuss one.
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Psychiatric Disorder: Dementia
Physiological changes of elderly influence cognitive functioning, for instance:
A reduced visual acuteness and accommodation can result in diminished capability to process
visual cues. Yellowing and flattening of the cornea can lead to difficulty distinguishing colors.
Furthermore, fewer functional cochlear cells can lead to diminished ability to process auditory
input.
3. For each behavior listed, specify whether it is associates with delirium (DL) or dementia
(DM).
The following behaviors associate with Delirium:
Hallucinations or delusions
A sudden, acute onset of symptoms
Incapacity to execute ADL
Behavior disorders often degenerate at night
Incoherent interaction with others
The following behaviors associate with Dementia
Slow and insidious onset
Progressive functional impairment
Patient may exhibit wandering behavior
4. Based upon the information provided by the daughter, do you think K.B. is showing
signs of delirium or dementia? Explain.
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Psychiatric Disorder: Dementia
K.B. is showing signs of DEMENTIA. Delirium presents with acute and reversible
symptoms.
5. You know there are four main types of dementia that result in cognitive changes. List
two of these types of dementia.
Two of the four types of Dementia are:
Alzheimer’s disease
Vascular dementia
6. How can one determine the level or degree of the dementia impairment?
Determination of the level or degree of the dementia impairment may include:
A psychologist may administer testing of neuropsychologic testing in the
major domains of thinking and memory; verbal and expressive abilities;
constructional skills and executive functions. The information helps
determine whether the patient is capable of continued handling of his or
her own finances, driving or IADLs.
7. K.B. has a number of diagnostic tests on order. From the tests listed, which ones use
determines a diagnosis of dementia?
Tests used to diagnose Dementia:
Mental status examinations
Toxicology screen
Mini-Mental State Examination
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Psychiatric Disorder: Dementia
CMP
CBC with differential
Thyroid function tests
RPR
Serum B12
HIV screening
CT
MRI
CASE STUDY PROGRESS
After reviewing K.B.’s history and diagnostic test results, K.B. receives a diagnosis of
Alzheimer’s Dementia. The physician calls a family conference to discuss the implications with
K.B. and his daughter.
8. What neuroanatomic changes present in individuals with Alzheimer’s Dementia?
The following neuroanatomic changes present in individuals with Alzheimer’s disease:
• Convoluted atrophy of the brain
• Microscopic plaques and tangles, chiefly in the cortex and hippocampus areas of the
brain
9. List at least three interventions you would plan for K.B.
Some interventions to plan for K.B may include:
Preserve continuity in daily routine; do not change daily activities.
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Psychiatric Disorder: Dementia
Teach his daughter and/or other caregivers to provide a safe environment at home for
K.B. To include such activities as permitting K.B. to cook unassisted (disconnect the
stove),
Conduct a risk assessment for falls and do not allow him to go out alone if he is prone to
disorientation.
Refer K.B. to his PCP for possible prescriptions for Rivastigmine (Exelon), Memantine
(Namenda) or galantamine (Razadyne) that decelerates the advancement of the disorder
and improve daily functioning when started during early stages of dementia.
Teach the family about support groups for caregivers
Educate the family in keeping K.B. environmental stimuli to a minimum.
CASE STUDY PROGRESS
K.B. discharges and sees his primary care physician two days later. K.B. receives a prescription
for donepezil (Aricept) 5mg 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 was medications
that could cure Alzheimer’s Disease.
10. How do you respond?
Provide honest responses when explaining to K.B’s daughter that Dementia has no cure
and that prescribed medication for K.B. (Aricept) only slows down progression of the disease
through benefitting cognitive function mainly in verbal skills, concentration and overall
Dementia symptoms
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Psychiatric Disorder: Dementia
CASE STUDY PROGRESS
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 he has shown no improvement at all. Are we wasting our
money?”
11. What is the best answer for her question?
Explain to K.B.’s daughter that, ultimately, Aricept will not cure your father; however,
many studies show that a prescription of Donepezil 5 or 10mg daily links with noteworthy
advances in cognitive function, as assessed by the Alzheimer’s disease Assessment Scale-
cognitive subscale (ADAS cog) after about 12 or 24 weeks of treatment. Additionally, there is
documentation of demonstrated substantial improvements in global function and activities of
daily living after 24 weeks of treatment. It is only two weeks of your father taking the
medication.
12. K.B.’s daughter mentions that she has found him out in the front yard and once in the
neighbor’s yard. What are some interventions that you can suggest to promote safety for
K.B?
• Obtain a wearable tracking device for K.B. Such devices can assist with locating him if he
wanders out of sight.
• Place locks on the doors that are more complex and difficult to open.
• Obtain a medical alert bracelet for K.B. that contains his name, address, and telephone number.
• Alert neighbors and the local law enforcement authorities about K.B.'s wandering tendencies.
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Psychiatric Disorder: Dementia
• Consider installing a door alarm device that would provide warning if he opens the door.
