Introduction
Mr. M’s case illustrates an example of an age-related cognitive impairment. Considering the rapid onset of the patient’s symptoms and the history of hypertension, vascular dementia seems to be the most appropriate diagnosis for him. The present paper will provide a rationale for selecting the primary and secondary diagnoses, discuss the negative effects of the patient’s condition on his life, and outline some possible interventions.
Clinical Manifestations
Mr. M demonstrates clinical symptoms are associated with several types of dementia. He shows memory deficits, aggression, and delusion, which are associated with Alzheimer’s disease [AD] (Li, Hu, Tan, Yu, & Tan, 2014). He also has cognitive deficits (vascular dementia [VaD]), and behavioral disinhibition manifested as mood swings and impulsivity (frontotemporal lobar dementia [FTLB]) (Cunningham, McGuinness, Herron, & Passmore, 2015). Mr. M’s increasing dependence and inability to perform many ADLs may be attributed to “executive dysfunction with relative sparing of episodic memory and visuospatial skills” (FTLB) (Cunningham et al., 2015, p. 81). In addition, the patient’s health history includes a record of unsteady gait, which is regarded as one of the strongest predictors of non-AD dementias (Beauchet et al., 2016). Considering this, it is valid to presume that Mr. M likely has non-AD dementia.
Primary and Secondary Medical Diagnoses
Although Mr. M’s symptoms indicate that he might have AD, VaD is the primary diagnosis for him. This type of dementia is the second most prevalent and usually develops in close association with vascular risk factors, including elevated blood pressure (Emdin et al., 2016). Considering that the patient has a history of hypertension, his brain’s blood vessels might have become damaged, resulting in cognitive impairment.
Another reason why VaD should be the main diagnosis is that besides being predicted by unsteady gait, it is normally associated with a more rapid (sometimes sudden) onset of symptoms (Beauchet et al., 2016; Alzheimer’s Society, n.d.). Based on the speed of symptom progression, it may be suggested that Mr. M may also have FTLB (Alzheimer Society of Canada, n.d., para. 1). Lastly, there is still a chance that the patient may have AD since it is the most common type of dementia and, in the 90% of cases, occurs at the age of 65 or more (unlike FTLB that often occurs in younger individuals) (Bature, Guinn, Pang, & Pappas, 2017; Cunningham et al., 2015).
Expected Results of Nursing Assessment
Besides a detailed evaluation of patients’ health history, nurses should examine family, social, and occupational history. According to Scarabino, Gambina, Broggio, Pelliccia, and Corbo (2015), if a person’s first‐degree relative or parent has or had dementia, they face an increased risk of this disorder. In addition, it is observed that the level of one’s occupation, education, and physical activity throughout the lifespan allows building their cognitive reserve or “resilience against age-related brain pathology” (Evans et al., 2018, p. e0201008). Thus, during a nursing assessment, it may be revealed that Mr. M had a family history of dementia, low occupational, academic functioning, and/or physically passive lifestyle.
Physical, Psychological, and Emotional Effects of Dementia
All forms of dementia lead to progressive deterioration of functioning, which may be regarded as one of the key negative physical effects of this disease. At the same time, a decline in physical capabilities is closely linked to significant psychological distress. Patients may feel anxious and depressed due to loss of independence and the overall lifestyle they have led and may also fear and feel grief anticipating further health aggravations and death (Blandin & Pepin, 2017). As for the patient’s relatives, they can also be excessively stressed due to a deteriorating health condition of their loved one and a growing need to take care of him. Specific dementia-associated burdens on caregivers include financial expenses, chronic fatigue, risk of conflicts, hostility towards receivers of care, and social isolation (Razani et al., 2014). It means that both the patient and his family must be educated on the ways to cope with dementia-related risks.
Interventions
Both pharmacological and non-pharmacological interventions are available for Mr. M. For instance, it is essential to revise the list of his current medications and exclude such drugs as Xanax since they increase the risk of dementia (Cunningham et al., 2015). Consequently, the patient may be prescribed with acetylcholinesterase inhibitors (AChEis), “the only medications currently licensed for the treatment of dementia” (Cunningham et al., 2015, p. 85). However, it is worth noting that AChEis can be prescribed to him only in the case of AD diagnosis.
Though dementia cannot be cured, its progression may be delayed through daily physical exercise and cognitive exercise. Thus, non-pharmacological interventions may include walking and moderate-intensity physical activity, computer-based attention and memory training (Smith et al., 2017). Moreover, considering the previously discussed emotional effects of dementia, it is essential to conduct psychoeducation for Mr. M and his family. Educational sessions can help to build their emotional resilience to the disease and provide them with necessary information about existing support sources.
Summary: Actual and Potential Problems
As the conducted case analysis revealed, the main symptom that Mr. M is experiencing is the loss of functional capacity. Thus, the first problem that he is now facing is non-adherence to previously prescribed treatment for hypertension. As the delirium state, memory loss, and other functional impairments will aggravate further, it will be increasingly difficult for him to control his health independently. For the same reason, his ability to keep track of many other spheres of life including finance will decline as well, which means that Mr. M’s position is becoming more vulnerable. As a result of delirium and memory deficit, the patient’s security can also be threatened since he can get lost and abused easily. Lastly, the patient’s risk of social isolation and conflict is now increased. Due to cognitive and functional problems, Mr. M cannot maintain an interactive lifestyle at the same level as before, whereas his emotional swings may be misinterpreted by others and responded with hostility. After the accurate diagnosis, all these problems must be promptly addressed through appropriate interventions.
References
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