Mr. M is an elderly man living in a facility who lately has been raising concerns among the medical staff. A few months ago, despite some difficulties with physical activities, Mr. M was able to take care of himself. He could get dressed, bathe, and feed himself without any assistants. Currently, Mr. M is displaying disturbing behaviors: firstly, he appears to be suffering from memory losses. He no longer recalls the names of his family members, forgets his room number, and repeats the information that he has just read. Aside from that, Mr. M has become more irritable and aggressive as well as more fearful and agitated. These days, Mr. M is found wandering the facility and appearing completely lost. The rapid decline in Mr. M’s abilities to maintain his normal life requires a thorough medical investigation.
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Based on the information presented in the case scenario, primary and secondary diagnoses would be Alzheimer’s and hypertension. The behavior described above fits the criteria for Alzheimer described in the DSM-5: confusion, disorientation, aggression, memory lapses (American Psychiatric Association, 2015). One would expect the CT head to show changes characteristic for this condition. However, the lack thereof might be explained by the early stages of the diseases. As for hypertension, the medical history of Mr. M suggests that he has been suffering from high blood pressure. Aside from that, based on the patient’s heart rate, he appears to have tachycardias.
Another potential diagnosis for Mr. M would be diabetes: when this condition is poorly controlled, it can lead to delirium (Lopes & Pereira, 2018). This delirium is characterized by the same concerning behaviors displayed by Mr. M: fever, memory loss, fearfulness, and inability to clearly communicate and function independently. However, Mr. M’s blood test results are not exactly indicative of diabetes: one would expect protein in his urine and excessive blood sugar, which is not the case. Apart from that, Mr. M is not overweight while obesity is one of the predisposing factors for diabetes.
Physically, Alheimer’s syndrome can manifest itself through the loss of balance or coordination and muscle stiffness. When Mr. M walks, he is likely to shuffle or drag his feet; on top of that, he might have trouble standing or sitting up in a chair. Alzheimer’s syndrome is characterized with such physical symptoms as weak muscles and fatigue, disturbed sleep, trouble controlling one’s bladder or bowels, seizures, and uncontrollable twitches (Budson & Solomon, 2015). With his new health status, Mr. M is likely to be experiencing such neuropsychiatric symptoms as depression, apathy, aggression, and psychosis, which constitute the core of Alzheimer’s disease (Budson & Solomon, 2015). Emotionally, people with dementia start feeling confused more and more often (Budson & Solomon, 2015). When they cannot make sense of the world around them, they feel frustrated and angry with themselves.
Mr. M’s family may be experiencing the adverse impact of having a relative with Alzheimer’s, even though he is living in a facility and does not require constant supervision. Since Mr. M’s has only recently deteriorated, his relatives might have a difficult time adjusting to his new status. The patient’s family remembers him as an able man who was able to take care of himself and communicate, which might not soon be the case anymore. Overall, it is only natural that Mr. M’s family would feel distraught and frustrated and be unsure about how to proceed. Now they will have to learn how to deal with Mr. M’s cognitive decline, disturbing behaviors, and volatile emotional states in a way that they could still have bonding experiences when visiting him.
Mr. M and his family might benefit from educational interventions. His family needs to receive information from specialists on how to handle Mr. M’s new status. Counseling might include advice and recommendations on such aspects as memory loss, communication, and episodes of aggression. For example, family members might learn that they have to reintroduce themselves every visit so that Mr. M and they are on the same page. Medical staff might want to suggest bonding rituals that could strengthen family ties despite the disease. For instance, Alzheimer’s patients have found to be perceptive of music, which can be used during visits (Budson & Solomon, 2015). Lastly, the family can be referred to a support group where they could express their feelings and share their experience.
Given Mr. M.’s current condition, he is likely to need more assistance now and in the future. His dementia may progress, leaving him even less capable of fulfilling simple everyday tasks such as eating, dressing, and cleaning. The second problem is his alienation from other, healthier patients as well as some relatives as they might find it difficult to communicate with him now. Confusion, disorientation, and psychosis are quite disturbing for those who have not had specialized medical training to handle them. Further, Mr. M himself might start experiencing the emotional ramifications of his state. As he starts feeling confused more often, he is likely to feel anger toward himself. Lastly, Mr. M might discover that he can no longer handle stress in a healthy way. The slightest inconveniences have the potential of setting him off and trigger an episode of aggression.
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- American Psychiatric Association. (2015). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
- Budson, A. E., & Solomon, P. R. (2015). Memory Loss, Alzheimer’s disease, and dementia e-book: A practical guide for clinicians. Elsevier Health Sciences.
- Lopes, R., & Pereira, B. D. (2018). Delirium and psychotic symptoms associated with hyperglycemia in a patient with poorly controlled type 2 diabetes mellitus. Innovations in Clinical Neuroscience, 15(5-6), 30.