Alzheimer’s disease is a dangerous condition of the brain most common among older people. Scientists note that the disease is the third leading cause of death in the United States after cardiovascular disease and cancer (Bredesen et al., 2016). The treatment is usually aimed at alleviating the symptoms, as nowadays, the condition is considered incurable. Besides, the correct diagnosis in the early stages of the disease is deemed to be essential. This paper aims to evaluate Mr. M’s situation, discuss the diagnosis and expected abnormalities, as well as physical, psychological, and emotional effects, possible interventions, and potential problems in the future.
Clinical Manifestations
Mr. M.’s clinical manifestations include troubles recalling the names of his family members, remembering his room number, and repeating what he just read. Moreover, Mr. M. is becoming aggressive and agitated quickly and appears to be afraid and fearful when he gets aggressive. Recently he has been found wandering at night; he frequently becomes lost and needs help to get back to his room. Mr. M. is also losing the ability to take care of himself, whereas a few months ago, he was able to wash, dress, and feed himself.
Medical Diagnosis
Mr. M.’s memory troubles, wandering, aggression, and agitation are apparent symptoms of the moderate phase of Alzheimer’s disease. Unfortunately, Mr. M. has recently started losing the ability to take care of himself, which is a primary symptom of the advanced stage of the disease. First of all, Mr. M. will have to undergo magnetic resonance imaging (MRI), since it is the most reliable method to prove the diagnosis of Alzheimer’s disease. Neuropsychological testing is usually carried out for patients with pre-dementia (Bredesen et al., 2016). Mr. M. has already started having problems with memorizing the things he just read; that is why there is no need for additional testing.
Expected Abnormalities
Along with the symptoms described above, there are also some abnormalities in Mr. M.’s laboratory results. In particular, his urinalysis is positive for a moderate amount of leukocytes and cloudy, which signalizes that the patient has urinary tract infections (UTI). In older people with dementia, these infections often cause delirium and increased mortality (Lam, 2018). That is why Mr. M. should immediately undergo UTI treatment.
Physical, Psychological and Emotional Effects
Accompanying symptoms associated with a worsened psycho-emotional state of the patient is the usual reaction to memory problems and difficulties with performing simple everyday activities. Most often, these symptoms occur in moderate and advanced stages of the disease. To reduce the destructive effects of aggression and agitation, health workers usually recommend behavioral, emotional, cognitive, and stimulatory-oriented therapies. Since aggressive behavior hurts the patient loved ones, family members may also receive supportive care.
Therapies and Interventions
Behavioral interventions are aimed at changing the patient’s response, which can be potentially harmful. For example, the caregiver ensures that the patient does not stay alone for a long time, especially in the evening, and wears a bracelet with personal information. Besides, the patient should remain in place with a reduced likelihood of physical injuries. Often, behavioral therapy involves making memory sticks that help the patients to follow the regimen and take care of themselves at the moderate stage. Emotional interventions are aimed at improving the patient’s emotional state and may include reminiscence therapy, validation therapy, supportive psychotherapy, and simulated presence therapy.
Cognitive therapy is based on reality orientation and cognitive retraining; to help the patient navigate reality, doctors recommend caregivers reminding him of time, place, and people. At the same time, cognitive retraining implies mind exercises, which can sometimes cause frustration in patients in later stages. Stimulatory-oriented therapy is usually aimed at reducing aggression and agitation and includes music therapy, light therapy, aromatherapy, and exercises. According to scientists, the most dramatic changes in patients’ conditions are related to music therapy, while light treatment reduces irritability and fatigue in family members providing care (Millán-Calenti et al., 2016). Stimulatory interventions may also include exercises, which usually give good results.
Current and Potential Problems
The most dangerous symptom Mr. M. is facing right now is wandering. The staff of the living facility will likely have to lock Mr. M. in the room in the evenings to avoid possible falls and injuries, which are a common reason for death in patients with Alzheimer’s disease. Aggression and agitation are equally dangerous, as they may also result in injuries. Another issue bringing a lot of inconveniences are memory troubles, which can cause hard frustration. Finally, Mr. M. has difficulties taking care of himself and has to rely on the help of health workers. In the advanced stage of the disease, Mr. M. may experience even more severe symptoms such as long-term memory disruption, false identification syndrome, and delirium.
Thus, Mr. M’s diagnosis and expected abnormalities were discussed, and possible physical, psychological and emotional interventions were described. To summarize it, Mr. M. should undergo the MRI to have the diagnosis of the moderate stage of Alzheimer’s disease proved. Immediate UTI treatment should also be provided, as UTI infections in older people with dementia may cause delirium and even death. Besides, Mr. M. is recommended to undergo behavioral, cognitive, and stimulatory-oriented therapy, which will help to reduce the existing symptoms and improve his quality of life.
References
- Bredesen, D. E., Amos, E. C., Canick, J., Ackerley, M., Raji, C., Fiala, M., & Ahdidan, J. (2016). Reversal of cognitive decline in Alzheimer’s disease. Aging (Albany NY), 8(6), 1250.
- Lam, Y. F. (2018). Antipsychotic‐associated urinary tract infections in the elderly. The Brown University Psychopharmacology Update, 29(10), 2-3.
- Millán-Calenti, J. C., Lorenzo-López, L., Alonso-Búa, B., De Labra, C., González-Abraldes, I., & Maseda, A. (2016). Optimal nonpharmacological management of agitation in Alzheimer’s disease: Challenges and solutions. Clinical Interventions in Aging, 11, 175.