Dementia Treatment

Eleanor is a 77-year-old white female resident of a skilled nursing facility. Recently her daughter requested an evaluation from the staff psychologist because she noticed that her mother’s Alzheimer’s symptoms appeared to be getting worse. Eleanor was admitted to the facility six months ago with moderately severe cognitive and physical decline and had to be placed in a skilled facility since she could no longer manage herself at home. Her daughter is a single mother of four teens and works too many hours to care for her mother in her home. She had attempted to care for her until Eleanor left the stove on, resulting in a minor kitchen fire. Eleanor has no history of mental illness, but she began to show signs of cognitive decline in her late fifties. The symptoms became much more pronounced after her husband’s death five years ago.

Recently her daughter and other members of the nursing staff noticed that Eleanor has become rather restless and combative. When she gets confused over her surroundings, she wanders through the halls attempting to open fire doors. When nurses attempt to redirect her back to her room, she swears at them and even struck one of them in the face. Her PCP authorized the use of restraints one day after she managed to wander out the front door and was found standing in the middle of the street trying to take a dog away from a woman who was walking it. She yelled at the woman, telling her that she needed the dog to protect her from people who were stealing her clothing in the nursing home.

• Summarize the clinical case.
• Create a list of the patient’s problems and prioritize them.
• Which diagnosis should be considered
• What is your rationale for the diagnosis
• What differential diagnosis should be considered
• What test or screening tools should be considered to help identify the correct diagnosis
• What treatment would you prescribe and what is the rationale (consider psychopharmacology, diagnostics tests, referrals, psychotherapy, psychoeducation)
• What standard guidelines would you use to assess or treat this patient