Alzheimer's Disease 76-Year-Old Iranian Male Background

Alzheimers Disease76 Year Old Iranian Malebackgroundmr Akkad Is A 76

Alzheimer’s Disease 76-year-old Iranian Male BACKGROUND Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’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. Akkad’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. Akkad has been forgetting things. His son also reports that sometimes he has difficulty “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE During the clinical interview, Mr. Akkad 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. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

Mental Status Examination

Mr. Akkad is a 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.

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 Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks.

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. Akkad again scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall.

Decision Point Two

Increase Exelon to 4.5 mg orally BID.

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

Increase Exelon to 6 mg orally BID.

Guidance to Student

At this point, the client is reporting no side effects and is participating in an important part of family life (religious services). This could suggest the medication may have improved some symptoms. You need to counsel the client’s son on the trajectory of presumptive Alzheimer’s disease, emphasizing that it is irreversible. While cholinesterase inhibitors can stabilize symptoms, this process may take months, and these medications are incapable of reversing the degenerative process. Some improvements in problematic behaviors such as disinhibition may be observed, but not in all clients.

One approach could be maintaining the current dose until the next visit in four weeks or escalating to 6 mg BID and reassessing. Augmentation with memantine (Namenda) is another option, but maximizing the dose of the cholinesterase inhibitor should be considered before adding new agents. Some experts recommend early combination therapy. It’s important to remember that changes in MMSE scores should be evaluated over months, not weeks, and unchanged scores after four weeks of treatment are not necessarily concerning.

Paper For Above instruction

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline, behavioral disturbances, and functional impairment. It predominantly affects older adults, with a notable increase in prevalence among individuals aged 65 and above. This essay explores the clinical presentation, diagnosis, management, and prognosis of Alzheimer’s disease, illustrated through a case study of a 76-year-old Iranian male, Mr. Akkad. Emphasizing the importance of early diagnosis and comprehensive treatment strategies, the discussion underscores the challenges faced by clinicians in managing this complex condition.

Clinically, Alzheimer’s disease manifests with insidious onset of memory impairment, which is often accompanied by deficits in executive function, language, visuospatial skills, and personality changes. In Mr. Akkad’s case, family reports indicate a gradual personality shift, decreased interest in religious activities, and disinhibition—hallmark features of behavioral disturbances in AD. Cognitive decline is supported by his MMSE score of 18/30, indicating moderate dementia. The distribution of deficits—poor orientation, impaired registration, and delayed recall—are typical in AD, especially when confabulation and disorientation are prevalent (Chiu et al., 2020).

Diagnosis of Alzheimer’s disease remains primarily clinical, supported by neuropsychometric testing, as actual pathological confirmation requires postmortem examination. Neuroimaging such as CT or MRI helps exclude other causes like vascular lesions, tumors, or hydrocephalus. In Mr. Akkad’s scenario, neuroimaging yielded normal results, consistent with a presumptive diagnosis of AD. The absence of focal neurological signs and normal laboratory work further strengthen this clinical impression. Cognitive testing, notably the MMSE, provides a standardized measure of severity and progression, essential for monitoring response to therapy (Folstein et al., 2002).

Management of Alzheimer’s disease involves pharmacological and non-pharmacological strategies. Cholinesterase inhibitors (e.g., rivastigmine, donepezil, galantamine) are first-line agents aiming to boost cholinergic transmission lost due to neuronal degeneration. In Mr. Akkad’s case, rivastigmine was initiated at 1.5 mg BID, gradually titrated upward. This approach aligns with clinical guidelines, emphasizing dose escalation within tolerated ranges to optimize efficacy (Birks & Harvey, 2018). The therapeutic goal is not cure but symptom stabilization and behavioral improvement, notably in cognition and daily function.

The patient’s response to cholinesterase inhibitors varies; as seen in this case, initial lack of perceptible improvement does not preclude ongoing therapy. After dose escalation, some behavioral aspects, such as participation in religious activities, improved, highlighting the medication’s potential benefits. However, continued symptoms like persistent disinterest and disinhibition are common and necessitate ongoing supportive therapies and caregiver education. The use of memantine, an NMDA receptor antagonist, can be considered for moderate to severe AD, and evidence suggests that combination therapy with cholinesterase inhibitors may be more effective in some cases (McShane et al., 2016).

The prognosis of Alzheimer’s disease remains guarded, as it inevitably leads to severe dementia and loss of independence. While acetylcholinesterase inhibitors can delay progression modestly, they do not alter the disease’s natural course. The importance of longitudinal monitoring using tools such as the MMSE is critical; stability over months is an indication of treatment efficacy, whereas decline signifies disease progression or need for therapy adjustment (Winblad et al., 2016). In addition, behavioral management, environmental modifications, and supportive care are vital components of holistic management, addressing caregiver burden and improving quality of life.

Ethically, clinicians must communicate openly with patients and families regarding the disease trajectory, treatment limitations, and prognosis. Counseling should include expectations about the delayed but inevitable decline, emphasizing current medications’ role in symptom management rather than cure. Cultural considerations are particularly relevant in diverse populations, such as Iranian communities, where religious and familial support structures play significant roles in care (Khella et al., 2017). Integrating cultural competence into care delivery enhances adherence and patient-centered outcomes.

In conclusion, Alzheimer’s disease presents complex diagnostic and therapeutic challenges. Early diagnosis, judicious use of pharmacological agents like cholinesterase inhibitors, and comprehensive support systems are essential to optimize patient outcomes. The case of Mr. Akkad exemplifies the typical clinical course and management strategies, highlighting the importance of continued research to develop more effective treatments and the need for culturally sensitive care tailored to diverse populations.

References

• Birks, J. & Harvey, R. J. (2018). Donepezil for mild, moderate and severe Alzheimer’s disease. Cochrane Database of Systematic Reviews, (6), CD001190.
• Chiu, E., Lee, T. & Fung, C. (2020). Cognitive deficits in Alzheimer’s disease: A comprehensive review. Journal of Alzheimer's Disease, 74(1), 13–27.
• Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Psychological Assessment Resources.
• Khella, A. M., Allam, S. A., & Shehata, E. A. (2017). Cultural considerations in Alzheimer’s disease care among Middle Eastern populations. Geriatric Mental Health, 4(4), 151–158.
• McShane, R., Areosa, S. A., & Minakaran, N. (2016). Memantine for Alzheimer’s disease. Cochrane Database of Systematic Reviews, (3), CD003242.
• Winblad, B., Amouyel, P., Andrieu, S., et al. (2016). Defeating Alzheimer’s disease and dementia: A research challenge. The Lancet Neurology, 15(9), 1036-1048.