Neurologic and Musculoskeletal Disorders 

Neurologic and Musculoskeletal Disorders

Instructions/Descriptions

Neurologic and Musculoskeletal Disorders

Case Study

J.D is a 86 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. J.D was seen by his family physician who ruled out any organic basis for Mr. J. D’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal. According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. J. D’s personality began to change a few years ago.

He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.” Over the course of the past two years, the family has noticed that Mr. J. D’s has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

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During the clinical interview, Mr. J. D’s is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. J. D’s 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. J. D’s 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.

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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.

Decision Point One: Begin Aricept (donepezil) 5 mg orally at BEDTIME

RESULTS OF DECISION POINT ONE

• Client returns to clinic in four weeks
• The client is accompanied by his son who reports that his father is “no better” from this medication.
• He reports that his father is still disinterested in attending religious services/activities, and continues to exhibit disinhibited behaviors.
• You continue to note confabulation and decide to administer the MMSE again. Mr. J. D’s again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall.

Decision Point Two : increase Aricept to 10mg orally at bedtime

RESULTS OF DECISION POINT TWO

•  Client returns to clinic in four weeks
•  Client’s son reports that the client is tolerating the medication well, but is still concerned that his father is no better
•  He states that his father is attending religious services with the family, which the son and the rest of the family is happy about. He reports that his father is still easily amused by things he once found serious

Decision Point Three : continue Aricept to 10mg orally at bedtime

At this point, it would be prudent to continue Aricept at 10 mg orally at bedtime. Recall that this medication can take several months before stabilization of deterioration is noted. At this point, the client is attending religious services with the family, which has made the family happy.

Assignment

Write a 2 to 3-pages summary paper that addresses the following:

• Briefly summarize the patient case study assigned, including each of the three decisions you took for the patient presented.
• Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
• What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
• Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

Neurologic and Musculoskeletal Disorders

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