Patient Presentation
My patient is a 69-year-old woman named Eva. She came to me complaining about concentration, memory, and perception problems. In addition to memory loss and cognitive impairment, other symptoms include aphasia, loss of abstract thinking, and impaired judgment. The woman forgets her relatives and gets lost in her home street. This has been going on for six months. Eva had no previous cognitive impairment. It is worth mentioning that the woman has type 2 diabetes and also underwent surgery to remove a hernia. She has a husband and two children, friends, and a dog.
Possible Diagnoses
The exponential increase in the prevalence of cognitive disorders with the increasing age of patients points to their connection with involutional morphological changes in the brain, which naturally develop as the brain ages. With age, the number of neurons, dendrites, synapses, and receptors in the brain decreases, and glial elements are lost (Crapser et al., 2021). A consequence of this is a decrease in the volume of the brain and its parts, the level of metabolism, and perfusion of the brain according to the data of functional neuroimaging. A presumptive diagnosis may be the initial stage of dementia. Dementia does not develop overnight – it is usually preceded by a more or less prolonged transitional stage when cognitive impairment has not yet reached the degree of dementia but is already out of the age norm. A significant portion of the elderly eventually develops severe cognitive deficits, resulting in the patient losing his or her ability to work and then his or her independence in daily life. Although the risk of dementia increases exponentially with age, this condition is not an inevitable attribute of aging and is not solely due to age-related changes in the brain. Dementia is also always based on pathological processes (degenerative, vascular, metabolic) leading to organic brain disease. Parkinson’s, Huntington’s, and prion diseases can also be possible.
Formation of the Diagnosis
Certain organic brain illnesses (such as normotensive hydrocephalus and chronic subdural hematoma), metabolic disorders (including hypothyroidism and vitamin B12 insufficiency), and poisoning can cause delayed cognitive decline that improves with therapy. These illnesses are commonly referred to as reversible dementia, while other experts limit the word “dementia” to cases characterized by permanent cognitive decline.
Treatment
In a disease such as dementia, unfortunately, treatment does not change the course of the disease. Medications are selected depending on the underlying organic disease. Symptomatic treatment of dementia is done with neuroleptics, antidepressants, and sleeping pills (Magierski et al., 2020). Thus, I may prescribe this patient antidiabetic drugs (acetylcholinesterase inhibitors and memantine), antiepileptic drugs (phenobarbital), and antihypertensives. In addition to drug therapy, music therapy, psychotherapy, and occupational therapy are effective and useful for Eva. Of particular importance is the care of the patient by his relatives. The patient should receive medication, care, support, and adequate care. Also, if necessary, treatment includes careful blood pressure control – taking medications to normalize it. Teaching the patient to adapt to society through psychological work is important. If dementia is serious, the patient should receive regular care and a caregiver.
Long-Term Care Plan for the Patient
Complications of the disease can be social disadaptation, which manifests in a person’s inability to communicate with the people around him because of certain problems. Prevention requires careful monitoring of blood pressure and, if necessary, prescribing the patient blood pressure-lowering drugs, walks in the air, and moderate physical activity. Also, integral factors may be the development of intelligence: learning foreign languages, and computers, a healthy diet that involves limiting fats, eating fruits, vegetables, and salads, a healthy lifestyle, and giving up smoking and alcohol.
References
Crapser, J. D., Arreola, M. A., Tsourmas, K. I., & Green, K. N. (2021). Microglia as hackers of the matrix: sculpting synapses and the extracellular space. Cellular & molecular immunology, 18(11), 2472-2488. Web.
Magierski, R., Sobow, T., Schwertner, E., & Religa, D. (2020). Pharmacotherapy of behavioral and psychological symptoms of dementia: state of the art and future progress. Frontiers in pharmacology, 11, 1168. Web.