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DISCUSSION POST # 1 Reply to Jinkee

The first step in assessing a patient is to check their muscle strength, balance, and coordination. Because of her advanced age, the patient's balance and coordination may suffer, resulting in a decline in her physical mobility. The provider can also examine the patient's memory by employing memory recall assessment instruments. Sensory examinations, such as superficial, deep cortical, and position sensory tests, must be performed to determine whether the patient has other sensory deficits. This will assist the provider in ruling out other illnesses that are primarily concerned with coordination and movement, such as Parkinson's disease.  

Top 3 Differential Diagnosis

1. Frontotemporal Dementia (FTD) - Frontotemporal dementias are a group of clinically and neuropathologically heterogeneous neurodegenerative disorders characterized by prominent changes in social behavior and personality or aphasia accompanied by degeneration of the frontal and/or temporal lobes (UpToDate, 2021). This means that people are more prone to experience behavioral and emotional changes, as well as difficulty judging situations.  Memory problems are less common or appear later in life. Younger persons, often those under the age of 65, are more likely to be affected. This type of dementia may affect a person's personality and ability to inhibit behaviors that they previously could. FTD is one of the more prevalent forms of early-onset dementia.

2. Alzheimer’s Dementia (AD) - Alzheimer disease is a neurodegenerative disorder of uncertain cause and pathogenesis that primarily affects older adults and is the most common cause of dementia (UpToDate, 2021). Selective memory impairment is the most important and frequently first clinical sign of Alzheimer's disease. While therapies are available to alleviate some of the illness's symptoms, there is no cure, and the condition inexorably advances in all individuals.

3. Dementia with Lewy Bodies (DLB) - Dementia with Lewy bodies (DLB) is one of the most common types of degenerative dementia, second to Alzheimer disease (AD). In addition to dementia, distinctive clinical features include visual hallucinations, parkinsonism, cognitive fluctuations, dysautonomia, sleep disorders, and neuroleptic sensitivity (UpToDate, 2021). The presence of eosinophilic intracytoplasmic inclusions called Lewy bodies, which contain aggregated alpha-synuclein, is the pathological characteristic of DLB.

The first treatment plan will focus on the patient's memory training; if the patient has proven memory loss after analyzing the patient's memory, then the patient's cognitive function must be treated first. This will assist the provider in determining the patient's ability to do all of the interventions they choose. It may be necessary to refer the patient to a neurologist for additional evaluation. The neurologist would perform more tests to rule in or out diagnosis and also rule out any other possible causes for the patient's symptoms. Treatments for Alzheimer's disease frequently include medications to help with memory and other cognitive difficulties, in addition to guidance and tools for caregivers.

DISCUSSION POST # 2 Reply to Talia

For a 72-year-ols female patient presenting with her daughter for her annual wellness exam and concerns about memory and physical decline over the past year, physical assessment is paramount. Alzheimer disease is an uncurable and progressive condition involving cognitive impairment, especially memory, and primarily affects older adults (Wolk & Dickerson, 2021). Older adults experiencing a progressive decline in memory and other functional impairment should prompt further investigation to rule out other contributing factors such as medication, electrolyte imbalances, urinary tract infection, and depression (Wolk & Dickerson, 2021). The presence and progression of dementia can be monitored with a Mini-Mental State Examination (MMSE) tool or the Montreal Cognitive Assessment (MoCA) (Wolk & Dickerson, 2021). The patient’s history and physical should be considered with the cognitive assessment tool to make a diagnosis (Wolk & Dickerson, 2021). 

Differential Diagnoses

· Vascular dementia - this type of dementia is related to cerebrovascular disease and presents with stroke like symptoms (Wolk & Dickerson, 2021). 

· Dementia with Lewy bodies - this is the second most common type of dementia after Alzheimer disease and is characterized by hallucinations, cognitive fluctuations, and sleep disturbances (Wolk & Dickerson, 2021).

· Frontotemporal dementia - this involves degeneration of the frontal and/or temporal lobes of the brain and causes social and behavioral alterations (Wolk & Dickerson, 2021).

Treatment Plan

The World Health Organization (2019) recommends physical activity in patients with normal cognitive function to promote brain health and reduce the cognitive decline. Smoking cessation should be encouraged. It is recommended to promote a healthy diet and encourage a Mediterranean style diet may reduce cognitive decline (World Health Organization, 2019). Alcohol consumption is not recommended and can lead to other complications. Social support and activities are recommended and are strongly connected to good health and well-being (World Health Organization, 2019). It is also recommended to properly manage weight and other health conditions such as hypertension, dyslipidemia, diabetes, and depression (World Health Organization, 2019).