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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Detail the clinical presentation of the typical patient with Alzheimer's disease

  • Describe the clinical course of the disease and typical patient outcomes

  • Describe how nonpharmacologic therapy is combined with pharmacologic therapy for patients with Alzheimer's disease

  • Recognize and recommend treatment options for disease-specific symptoms as well as behavioral/noncognitive symptoms associated with the disease

  • Educate patients and/or caregivers about the expected outcomes for patients with Alzheimer's disease, and provide contact information for support/advocacy agencies

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PATIENT PRESENTATION

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Chief Complaint

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"I want to die. I hate forgetting all the important things."

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History of Present Illness

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Barbara O'Neil is a 65-year-old woman who presents with her husband to the primary care clinic. She does not state any other information when asked what has brought her to the clinic for this visit. Her husband describes how over the past several months since their last visit, his wife has had increased memory loss. He notices that she frequently forgets to complete her normal daily activities, such as brushing her teeth, combing her hair, and getting dressed for the day. Several nights ago, he found her wandering down the street looking for their dog that passed away last month. When he tried to bring her home, she became tearful and withdrawn. Additionally, she has always taken her own medications without any help, but the pharmacy has been calling stating that she is late on her refills. He has found multiple bottles of unused medications in their bedroom. Over the past few months, their daughter has also mentioned that her mother appears depressed. She has noticed her decreased appetite, decreased concentration, and a lack of interest in her mother's favorite activities. The husband and daughter are wondering if the patient is suffering from depression.

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Past Medical History

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Mild cognitive decline diagnosed 6 months ago

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HTN

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Type 2 DM

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Hyperlipidemia

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Family History

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Mother had dementia and died of pneumonia at age 85. Father died of a MI at age 73. She has one brother, age 62, with HTN and diabetes.

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Social History

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Married and lives with her husband of 40 years; has one daughter aged 35; retired grade-school teacher

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Tobacco/Alcohol/Substance Use

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Thirty-three pack-year history; denies alcohol and illicit drug use

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Allergies/Intolerance/Adverse Drug Events

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Enalapril (cough)

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Galantamine (N/V); she self-discontinued the medication at 8 mg twice daily

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Medications (Current)

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Amlodipine 10 mg PO daily

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Metformin 750 mg PO twice daily

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Atorvastatin 20 mg PO daily

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Multivitamin PO daily

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Calcium carbonate 600 mg PO twice daily

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