Vascular Neurocognitive Disorder in a Patient Case Study

The case focuses on an older adult, and at 69 years old, he presented some memory and speech problems. The wife had noticed that her husband has been having difficulties remembering the names of his family members and close friends. The man has been experiencing these memory losses for the past few months. He was lost while driving in his own neighborhood and had missed several appointments. Upon neurological examination, the patient seems to forget two objects of three in only three minutes.

• The patient’s symptoms are consistent with those of an individual suffering from a vascular neurocognitive disorder. The possible disease is Alzheimer’s disease (AD), whose most distinct feature is memory impairment.
• According to Ulep et al. (2018), AD’s progression takes several months, and the initial symptoms include amnesia, where the language, visual-spatial, or executive dysfunction are affected.
• With time, the disease affects episodic memory, including the inability to store new information and forgetting appointments, names, or medications. These signs were consistent with the ones displayed by the patient.
• As people grow older, it is possible to become forgetful of essential things. Therefore, a conclusive test should be conducted to ascertain the patient’s condition. Arvanitakis et al. (2019) proposed using the Montreal Cognitive Assessment, which is helpful in the early detection of cognitive impairment.
• Once the disease is identified, the patient can be started with non-pharmacologic approaches such as cognitive training, reminiscence, art therapy, and appropriate physical exercises.
• These exercises might not be enough, requiring the need for medications. Some of the most reliable drugs for cognitive symptoms include acetylcholinesterase inhibitors, which help increase acetylcholine abundance (Arvanitakis et al., 2019). They come in different forms, and they help slow down cognitive decline.
• Examples include donepezil, which should be administered 5mg daily for the first six weeks, and past that, increase the dosage to 10mg daily (Arvanitakis et al., 2019).
• Rivastigmine capsule starts with 1.5mg before increasing it to 3mg, then progresses to 4.5mg, and finally 6mg when the patient builds tolerance (Arvanitakis et al., 2019). In each phase, the drug should be administered twice daily for two weeks apart from the last stage, where the patient can take it for as long as needed.

Reference

Arvanitakis, Z., Shah, R. C., & Bennett, D. A. (2019). Diagnosis and management of dementia. Jama Network, 322(16), 1589-1599.

Ulep, M. G., Saraon, S. K., & McLea, S. (2018). Alzheimer disease. The Journal for Nurse Practitioners, 14(3), 129-135.