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 1. Compare and contrast the pathophysiology between Alzheimer’s disease and frontotemporal dementia. 2. Identify the clinical findings from the case that supports a diagnosis of Alzheimer’s disease. 3. Explain one hypothesis that explains the development of Alzheimer’s disease 4. Discuss the patient’s likely stage of Alzheimer’s disease.
