Diagnosis
Differential Diagnoses
- 1- Alzheimer’s. It is characterized as an incurable degenerative disease of the central nervous system with a gradual loss of mental abilities such as memory, speech, and logical thinking (Lin et al., 2013). The risk of its development increases after 65 years. The patient’s wife reports her husband’s forgetfulness and his inability to recall recent events, which is gradually progressing. At the same time, he remembers old events. Also, patients are experiencing problems associated with temporal and spatial orientation, while the choice of words is accompanied by significant difficulties, which, in turn, affects communication as well as contributes to negative personality changes.
- 2- Major depression. A permanent sense of hopelessness and a lack of energy are the main symptoms of major depression (Hayward, Taylor, Smoski, Steffens, & Payne, 2013). The marked reduction of interest in life reported by the patient is another sign of major depression. The given patient answers questions appropriately, yet he cannot establish long eye contact and repeats questions. This shows decreased concentration.
- 3- Multi-infarct dementia. O’Brien and Thomas (2015) state that this disease is associated with vascular changes in brain tissue. Along with a significant decrease in memory, patients may experience getting lost in familiar places or difficulties with following given instructions. Sleep patterns and personal habits tend to be broken, which is not characteristic of this patient.
Final Diagnoses
- Alzheimer’s. The first symptom is that short-term memory decreases with the preservation of long-term memory. Complaints of elderly people of forgetfulness applying for the same information several times are quite typical for the first stages of Alzheimer’s disease (Lin et al., 2013). The second symptom noted by this patient is apathy. The interest in the usual leisure time decreases, and it becomes more difficult to practice a favorite hobby or go out for a walk. As a rule, at this stage, people cope with most household tasks and do not lose their self-service skills, but they may need help in doing the usual things from time to time.
- Hypertension. As shown by the patient’s blood pressure (BP 145/96), he is at stage 2 of hypertension, which creates serious threats to his life by increasing the possibility of strokes and heart attacks. Continuous headaches complicate the situation. The uncontrolled character of hypertension determined earlier and the prescribed medication (HCTZ 25 mg) also supports this diagnosis.
- BPH. The patient has Benign Prostatic Hypertrophy (BPH) and takes Saw Palmetto cap. 500 mg PO BID as prescribed earlier. Pagano, Laudato, Griffo, and Capasso (2014) emphasize the role of Serenoa repens in improving the urinary flow and reducing the frequency of night urination. Characteristic signs of this disease are problems with urination, increased urges, chronic fatigue, and a general lack of energy.
Plan Including test / Therapeutics / Education / No medication treatment
The treatment plan for the patient with Alzheimer’s, hypertension, and BPH should be comprehensive, taking several steps to maintain symptoms and preventing their deterioration. The following tests should be prescribed to the patient: magnetic resonance imaging (MRI) and computed tomography of the head (head CT) to differentiate from other diseases and assess the patient’s condition.
As noted by Iqbal, Liu, and Gong (2014), Alzheimer’s should be taken rather seriously. The fact is that the human brain is plastic enough, and the cells and parts of the brain can partially replace the affected areas, performing additional functions. To provide the brain with the possibility of such self-compensation, the number of neural connections should be high enough, which occurs in people with intellectual activity, hobbies, and a variety of interests. The manifestations of the identified final diagnoses are to be controlled by visiting a physician and a urologist annually, avoiding general hypothermia, and leading an active lifestyle. Proper prophylaxis of BPH and hypertension is a healthy diet (Barry et al., 2017). It is necessary to exclude fast food and limit the use of alcoholic beverages. Furthermore, phytotherapy may also be considered for the treatment of Alzheimer’s in this patient (Fang et al., 2017).
When the disease begins to progress, every opportunity should be used to maintain the patient’s ability to self-service, reduce his isolation from others, and try to prevent the development of depression. For example, better-matched glasses can help for the given patient as he has some problems with vision. The patient himself and his family should be educated to detect signs of Alzheimer’s and report them to a doctor, who will provide further recommendations. The awareness of how to care for the patient will be helpful for the family members.
Self Assessment
The patient should conduct self-assessments at home by answering the questions of special tests. For example, the Self-Administered Gerocognitive Examination (SAGE) developed by Ohio State University’s Wexner Medical Center may be suggested. The patient’s family should help him to access the test and understand instructions, yet the test should be completed personally. Any cognitive impairment should be noted by the patient and then reported to his physician. Hypertension and BPH are to be controlled by the patient in a similar manner.
References
Barry, M. J., Fowler, F. J., O’leary, M. P., Bruskewitz, R. C., Holtgrewe, H. L., Mebust, W. K., & Cockett, A. T. (2017). The American Urological Association symptom index for benign prostatic hyperplasia. The Journal of Urology, 197(2), 189-197.
Fang, J., Wang, L., Wu, T., Yang, C., Gao, L., Cai, H.,… Wang, Q. (2017). Network pharmacology-based study on the mechanism of action for herbal medicines in Alzheimer treatment. Journal of Ethnopharmacology, 196(1), 281-292.
Hayward, R. D., Taylor, W. D., Smoski, M. J., Steffens, D. C., & Payne, M. E. (2013). Association of five-factor model personality domains and facets with presence, onset, and treatment outcomes of major depression in older adults. The American Journal of Geriatric Psychiatry, 21(1), 88-96.
Iqbal, K., Liu, F., & Gong, C. X. (2014). Alzheimer disease therapeutics: Focus on the disease and not just plaques and tangles. Biochemical Pharmacology, 88(4), 631-639.
Lin, F. R., Yaffe, K., Xia, J., Xue, Q. L., Harris, T. B., Purchase-Helzner, E.,… Health ABC Study Group, F. (2013). Hearing loss and cognitive decline in older adults. JAMA Internal Medicine, 173(4), 293-299.
O’Brien, J., & Thomas, A. (2015). Vascular dementia. The Lancet, 386(4), 1698-1706.
Pagano, E., Laudato, M., Griffo, M., & Capasso, R. (2014). Phytotherapy of benign prostatic hyperplasia. A minireview. Phytotherapy Research, 28(7), 949-955.