Major neurocognitive disorder due to Alzheimer’s disease (presumptive)
Major neurocognitive disorder due to Alzheimer’s disease (presumptive)
MENTAL STATUS EXAM
Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When you asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.
Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)
RESOURCES
§ Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources.
Op
Options for Decisions below: Tips. Pick one that be a better option and answer all questions above. Need 3 x references
1. Begin Exalon 1.5 mg po bid with an increase to 3 mg po bid in two weeks( pt not feeling better).
2. Increase Exelon to 4.5mg orally bid( pt not feeling better)
3. Increase Exelon to 6mg po bid. ( Pt improved, dose could be maintained and checked in 4 wks, Namenda could also be added).
OR
1. Begin Aricept 5mg po bedtime ( pt no feeling better)
2. Increase Aricept to 10mg po ( Pt still not feeling Better NB Aricept at 5mg can be effective)
3. Continue Aricept 10 mg ( pt not any better) or ( 5mg with Namenda can be effective).
OR
1. Begin Razadyne 4 mg ( pt not feeling better)
2. Increase Razadyne to 24 mg extended release( Pt has seizures/SE)
3. Retart Razadyne ( pt has more s/e). Respidal not apprappriate.
Resource for references
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
· Chapter 10, “Basic Principles of Neuropharmacology” (pp. 73–77)
· Chapter 11, “Physiology of the Peripheral Nervous System” (pp. 79–90)
· Chapter 12, “Muscarinic Agonists and Antagonists” (pp. 91–107)
· Chapter 13, “Adrenergic Agonists” (pp. 109–119)
· Chapter 14, “Adrenergic Antagonists” (pp. 121–132)
· Chapter 15, “Indirect-Acting Antiadrenergic Agents” (pp. 133–137)
· Chapter 16, “Introduction to Nervous System Pharmacology” (pp. 139–141)
· Chapter 17, “Drugs for Parkinson Disease” (pp. 143–158)
· Chapter 18, “Drugs for Alzheimer Disease” (pp. 159–166)
· Chapter 19, “Drugs for Epilepsy” (pp. 167–189)
· Chapter 20, “Drugs for Muscle Spasm and Spasticity” (pp. 191–201)
· Chapter 57, “Drug Therapy of Rheumatoid Arthritis” (pp. 629–641)
· Chapter 58, “Drug Therapy of Gout” (pp. 643–651)
· Chapter 59, “Drugs Affecting Calcium Levels and Bone Mineralization” (pp. 653–672)
