NR 507 Week 7 Case Study

NR 507 Week 7 Case Study

1. Compare and contrast the pathophysiology between Alzheimer’s disease and frontotemporal dementia. 

Alzheimer’s disease (AD) and frontotemporal dementia (FTD) are neurodegenerative diseases of the brain that result in dementia. According to Haque & Levey (2019), dementia is a clinical syndrome comprising impairment of individuals’ cognitive functioning, barring them from living complete functional and autonomous lives. AD is a chronic brain degenerative disorder in which there is an abnormal accumulation of amyloid proteins in the brain, particularly amyloid-Ꞗ (AꞖ) peptides in the extracellular senile plaques and the development of intracellular neurofibrillary tangles (NFTs) that comprises hyperphosphorylated and microtubule-associated protein tau (Haque & Levey, 2019).

On the other hand, Khan & De Jesus (2021) define FTD as a spectrum of clinical syndromes associated with neuronal degeneration and primarily affects the frontal and anterior brain lobes. In AD, the abnormal proteins accumulate in the hippocampus, amygdala, cerebral cortex, and associated cerebral vessels. Both AD and FTD affect elderly patients above 65 years; however, according to Kumar & Tsao (2019), AD is the most common cause of cognitive decline and, therefore, dementia, which is associated with impaired memory, attention, language, comprehension, judgment, and reasoning. The cognitive impairment in AD has been found to be severe enough to disrupt an individual’s performance of activities of daily living.

Khan & De Jesus (2021), on the other hand, reports that FTD is the third most common cause of dementia in elderly patients of 65 years and above but is again the second most common cause of early onset dementia in patients who are below 65 years of age with the patients’ age ranges being 45-65. FTD is characterized by heightened semantic and behavioral activities, impairment of language, motor speech, and motor functioning (Giebel et al., 2020). In a comparison of the impact on the activities of daily living (ADLs) among patients with AD and FTD, research conducted by Giebel et al. (2020), there was not much difference between the two disorders; however, it was established that initiative and planning were severely affected in patients with FTD as compared to those with AD. Risk factors associated with AD include advancing age, genetics, traumatic brain injury, and other systemic diseases. While the etiological cause of FTD is mainly sporadic, genetics have been documented, especially on mutations for genes encoding for tau protein, granulin, and hexanucleotide.

2. Identify the clinical findings from the case that supports a diagnosis of Alzheimer’s disease.

According to Breijyeh & Karaman (2020), AD is associated with decreased thinking and independence in ADLs. Other features include impairment in memory, language, comprehension, judgment, and reasoning, and upon mental state examination, there is impairment in executive functioning, concentration, memory, praxis, attention, and visuospatial skills (Kumar & Tsao, 2019). From the patient’s history, supportive evidence for AD includes reports of worsening memory by his wife, impaired judgment, and visuospatial skills evidenced by wandering away from home. He also has impaired reasoning since he brought a stranger to their house to buy them a home security system that they already have, and he has problems dressing himself or balancing his checkbook. He also has a family history of AD from his father, who died at 78 due to AD. On mental state examination, he scores 12/30, and magnetic resonance imaging shows hippocampal atrophy.

3. Explain one hypothesis that explains the development of Alzheimer’s disease.

The Amyloid Hypothesis

The theory suggests that amyloid beta peptide degradation decreases with advancing age, and several other pathological conditions result in the accumulation of the beta peptides (Breijyeh & Karaman, 2020). The increased ratio of Aβ42/Aβ40 triggers the formation of Aβ amyloid fibril, causing induction of tau pathology and neurotoxicity. The consequence of these events is neuronal cell death and neurodegeneration (Breijyeh & Karaman, 2020). The main pathology in AD is an accumulation of amyloid-beta peptides in the brain’s temporal lobes and other neocortical structures with associated neuronal degeneration; therefore, this hypothesis supports the development of AD.

 

4. Discuss the patient’s likely stage of Alzheimer’s disease.

The staging of AD is based on the patient’s symptomatic presentation, which is categorized as preclinical/presymptomatic, early, middle, late, and psychological and behavioral symptoms in dementia. The patient’s stage is moderate AD, as his features are consistent with impaired global intellectual functioning, executive dysfunction, aphasia, apraxia, and poor visual-spatial skills. The patient gets lost around his neighborhood, finds it difficult to dress, and has mood problems. Additionally, his mental state examination result is consistent with moderate Alzheimer’s dementia.

References

Breijyeh, Z., & Karaman, R. (2020). Comprehensive Review on Alzheimer’s Disease: Causes and Treatment. Molecules, 25(24), 5789. https://doi.org/10.3390/molecules25245789

Giebel, C. M., Knopman, D., Mioshi, E., & Khondoker, M. (2020). Distinguishing Frontotemporal Dementia From Alzheimer Disease Through Everyday Function Profiles: Trajectories of Change. Journal of Geriatric Psychiatry and Neurology, 34(1), 66–75. https://doi.org/10.1177/0891988720901791

Haque, R. U., & Levey, A. I. (2019). Alzheimer’s disease: A clinical perspective and future nonhuman primate research opportunities. Proceedings of the National Academy of Sciences, 116(52), 26224–26229. https://doi.org/10.1073/pnas.1912954116

Khan, I., & De Jesus, O. (2021). Frontotemporal Lobe Dementia. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559286/

Kumar, A., & Tsao, J. W. (2019, August 18). Alzheimer Disease. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499922/

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Preparing the Assignment

Requirements

Read the case study below.

In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT.

Provides a minimum of two responses weekly on separate days; e.g., replies to a post from a peer; AND faculty member’s question; OR two peers if no faculty question using appropriate resources, before Sun., 11:59 pm MT.

Case Scenario

A 76-year -old man is brought to the primary care office by his wife with concerns about his worsening memory. He is a retired lawyer who has recently been getting lost in the neighborhood where he has lived for 35 years. He was recently found wandering and has often been brought home by neighbors. When asked about this, he becomes angry and defensive and states that he was just trying to go to the store and get some bread.

His wife expressed concerns about his ability to make decisions as she came home two days ago to find that he allowed an unknown individual into the home to convince him to buy a home security system which they already have. He has also had trouble dressing himself and balancing his checkbook. At this point, she is considering hiring a day-time caregiver help him with dressing, meals and general supervision why she is at work.

Past Medical History: Gastroesophageal reflux (treated with diet); is negative for hypertension, hyperlipidemia, stroke or head injury or depression

Allergies: No known allergies

Medications: None

Family History

Father deceased at age 78 of decline related to Alzheimer’s disease

Mother deceased at age 80 of natural causes 

No siblings

Social History

Denies smoking

Denies alcohol or recreational drug use 

Retired lawyer

Hobby: Golf at least twice a week

Review of Systems

Constitutional: Denies fatigue or insomnia

HEENT: Denies nasal congestion, rhinorrhea or sore throat.  

Chest: Denies dyspnea or coughing

Heart: Denies chest pain, chest pressure or palpitations.

Lymph: Denies lymph node swelling.

Musculoskeletal: denies falls or loss of balance; denies joint point or swelling

General Physical Exam  

Constitutional: Alert, angry but cooperative

Vital Signs: BP-128/72, T-98.6 F, P-76, RR-20

Wt. 178 lbs., Ht. 6’0″, BMI 24.1

HEENT

Head normocephalic; Pupils equal and reactive to light bilaterally; EOM’s intact

Neck/Lymph Nodes

No abnormalities noted  

Lungs 

Bilateral breath sounds clear throughout lung fields.

Heart 

S1 and S2 regular rate and rhythm, no rubs or murmurs. 

Integumentary System 

Warm, dry and intact. Nail beds pink without clubbing.  

Neurological

Deep tendon reflexes (DTRs): 2/2; muscle tone and strength 5/5; no gait abnormalities; sensation intact bilaterally; no aphasia

Diagnostics

Mini-Mental State Examination (MMSE): Baseline score 12 out of 30 (moderate dementia)

MRI: hippocampal atrophy

Based on the clinical presentation and diagnostic findings, the patient is diagnosed with Alzheimer’s type dementia.

Discussion Questions

Compare and contrast the pathophysiology between Alzheimer’s disease and frontotemporal dementia.

Identify the clinical findings from the case that supports a diagnosis of Alzheimer’s disease.  

Explain one hypothesis that explains the development of Alzheimer’s disease

Discuss the patient’s likely stage of Alzheimer’s disease.