i-Human Janet Riley, Alzheimer’s Dementia Case Study (A Graded) Latest Questions/i-Human Janet Riley, Alzheimer’s Dementia Case Study (A Graded) Latest Questions and Complete Solutions

PATIENT NAME – Janet Riley

AGE - 79 YEARS 

HEIGHT – 5’7” (170 cm)

WEIGHT - 110.0 lb (50.0 Kg) 

CHIEF COMPLAINT – Confusion and Memory Loss reported by Family Members

i-Human: Janet

Riley

Assessment

1. Alzheimer’s Dementia. Mrs. Riley has been experiencing symptoms of dementia such as

memory problems, difficulty concentrating, and forgetfulness that have progressively worsened

over the past 2 to 3 years (U.S. Department of Health and Human Services, National Institute on

Aging, 2019). Her daughter now reports symptoms of impaired memory, judgment, and

orientation; sundowning; decline in ability to perform activities of daily living (ADLs); mood

andpersonality changes; and symptoms of depression (U.S. Department of Health and Human

2. Services, National Institute on Aging, 2019). The physical examination findings of generalized

cortical atrophy and reduced hippocampal volume on brain MRI coupled with her scoring on

neurological exams (mini-mental state, geriatric depression, mini-cog, clock-draw) indicating

moderate cognitive impairment make this diagnosis the most plausible (U.S. Department of

Health and Human Services, National Institute on Aging, 2019).

3. Vascular Dementia. Mrs. Riley possesses various risk factors for vascular dementia including

coronary artery disease (CAD) status-post stent placement, hypertension, and hyperlipidemia.

Her history and physical examination findings indicate a progressive worsening of her dementia

symptoms as opposed to a stepwise progression such as in vascular dementia (Mayo Clinic,

2018). Additionally, the lack of evidence of previous infarction on brain MRI makes this

diagnosisless likely (Mayo Clinic, 2018).

4. Occult Infection (Urinary Tract Infection). Mrs. Riley’s undergarments are noted to smell of

urineraising the suspicion of incontinence which may be a sign of a urinary tract infection (UTI).

Additionally, her daughter reports a decline in Mrs. Riley’s personal hygiene and excessive body

odor is noted on exam. Mrs. Riley’s mental status changes may represent nonspecific symptoms

3

associated with UTI in older adults (Moody, 2020). The urinalysis and complete blood count

(CBC) findings are within normal limits thereby ruling this diagnosis out.

5. Subdural Hematoma. This diagnosis should be considered given Mrs. Riley’s fall with head

strikeand loss of consciousness 4 weeks prior coupled with her symptoms of worsening confusion

andbehavioral changes (Shelta, 2020). Lack of evidence of subdural hematoma on brain MRI

rules this diagnosis out.

Final Diagnosis: Alzheimer’s Dementia

Plan

Pharmacolog

y

• Donepezil 5 mg by mouth every morning. Dispense in blister pack.

• Citalopram 10 mg by mouth every evening for depression, agitation, and paranoia. Dispense in

blister pack.

• Discontinue PRN Ambien, as this may exacerbate dementia symptoms. May consider low dose

Trazodone if insomnia is more frequent.

Non-Pharmacology