Preparing The Assignment Requirements: Read The Case 334992

Preparing The Assignmentrequirements1 Read The Case Study Below2 In

Read the case study below. In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT. Provides a minimum of two responses weekly on separate days; e.g., replies to a post from a peer; AND faculty member’s question; OR two peers if no faculty question using appropriate resources, before Sun., 11:59 pm MT.

Case Scenario

A 76-year-old man is brought to the primary care office by his wife with concerns about his worsening memory. He is a retired lawyer who has recently been getting lost in the neighborhood where he has lived for 35 years. He was recently found wandering and has often been brought home by neighbors. When asked about this, he becomes angry and defensive and states that he was just trying to go to the store and get some bread.

His wife expressed concerns about his ability to make decisions as she came home two days ago to find that he allowed an unknown individual into the home to convince him to buy a home security system which they already have. He has also had trouble dressing himself and balancing his checkbook. At this point, she is considering hiring a daytime caregiver to help him with dressing, meals, and general supervision while she is at work.

Past Medical History includes gastroesophageal reflux (treated with diet); no hypertension, hyperlipidemia, stroke, head injury, or depression. Allergies: No known allergies. Medications: None. Family History: Father deceased at age 78 of decline related to Alzheimer's disease; mother deceased at age 80 of natural causes. No siblings.

Social History: Denies smoking, alcohol, or recreational drug use. Retired lawyer. Hobby: golf at least twice a week. Review of Systems: No fatigue, insomnia, nasal congestion, sore throat, dyspnea, chest pain, or lymph node swelling. No falls or balance issues. Physical Exam: Alert, cooperative, with vital signs within normal limits. Neurological Exam: normal reflexes, muscle strength, sensation, and gait.

Diagnostics: Mini-Mental State Examination (MMSE): baseline score 12/30 (moderate dementia). MRI: hippocampal atrophy. Based on clinical presentation and diagnostic findings, diagnosed with Alzheimer’s type dementia.

Discussion Questions

1. Compare and contrast the pathophysiology between Alzheimer's disease and frontotemporal dementia.
2. Identify the clinical findings from the case that supports a diagnosis of Alzheimer's disease.
3. Explain one hypothesis that explains the development of Alzheimer's disease.
4. Discuss the patient's likely stage of Alzheimer’s disease.

Paper For Above instruction

Alzheimer's disease and frontotemporal dementia are both neurodegenerative disorders characterized by progressive cognitive decline, but they differ significantly in their pathophysiology, clinical features, and affected brain regions. Understanding these differences is vital for accurate diagnosis and tailored management strategies.

The pathophysiology of Alzheimer's disease primarily involves the accumulation of amyloid-beta plaques and neurofibrillary tangles composed of hyperphosphorylated tau protein. These pathological hallmarks lead to synaptic dysfunction, neuronal death, and brain atrophy, particularly affecting the hippocampus and cortical areas responsible for memory and cognition (Blennow, de Leon, & Zetterberg, 2012). The progressive deposition of these proteins disrupts neural communication, resulting in the characteristic cognitive deficits. In contrast, frontotemporal dementia (FTD) involves atrophy of the frontal and temporal lobes, primarily owing to abnormal accumulations of tau, TDP-43, or FUS proteins, depending on the subtype (Murray et al., 2014). Unlike Alzheimer's disease, FTD often presents with prominent behavioral and personality changes or language disturbances rather than early memory impairment. The neuronal death in FTD is usually more localized to the frontal and temporal regions, correlating with behavioral and language deficits, whereas Alzheimer's affects the hippocampus and associative cortices, correlating with memory decline.

Clinically, Alzheimer’s disease often manifests initially with memory impairment, particularly affecting recent memory, as seen in this patient with a low MMSE score and hippocampal atrophy on MRI. The patient's difficulty in navigating familiar surroundings, difficulty with decision-making, and problems with instrumental activities like managing checkbooks support this diagnosis. Conversely, frontotemporal dementia typically presents with behavioral changes such as disinhibition, apathy, compulsive behaviors, or language impairments early in the disease course; these are absent in this case. The patient's preserved motor function, lack of changes in personality or language, and neuroimaging showing hippocampal atrophy further support Alzheimer's over FTD.

One prominent hypothesis for the development of Alzheimer's disease involves the amyloid cascade hypothesis, which posits that the accumulation of amyloid-beta peptides initiates a series of neurodegenerative processes. According to this theory, amyloid deposition triggers tau pathology, leading to neurofibrillary tangles, synaptic dysfunction, and neuronal death. Genetic factors such as ApoE4 allele increase amyloid accumulation, accelerating disease progression (Hardy & Selkoe, 2002). This hypothesis has guided many therapeutic approaches aimed at reducing amyloid burden, although previous treatments targeting amyloid have yielded mixed results, prompting ongoing research into other pathogenic pathways (Karran, Knapp, & De Strooper, 2011).

The stage of Alzheimer’s disease in this patient is likely in the moderate phase. With a MMSE score of 12, cognitive deficits are significant but not at a severe stage. Patients in moderate stages often experience substantial impairment in daily functioning, including difficulties with complex tasks, safety concerns, and behavioral disturbances. The patient's difficulty with dressing, balancing checkbooks, and recent wandering episodes indicates progression beyond mild cognitive impairment but not yet severe enough to require full nursing home placement. Functional impairments in instrumental activities of daily living are characteristic of this moderate phase, warranting interventions like caregiver support and environmental modifications.

References

• Blennow, K., de Leon, M. J., & Zetterberg, H. (2012). Alzheimer's disease. The Lancet, 378(9800), 2029-2039.
• Hardy, J., & Selkoe, D. J. (2002). The amyloid hypothesis of Alzheimer’s disease: Progress and problems on the road to therapeutics. Science, 297(5580), 353-356.
• Karran, E., Knapp, M., & De Strooper, B. (2011). The amyloid cascade hypothesis for Alzheimer’s disease: An appraisal for the development of therapeutics. Nature Reviews Drug Discovery, 10(9), 698-712.
• Murray, M. E., Johnson, J. E., Rollinson, S., et al. (2014). Frontotemporal dementia: A clinical review. Neurology, 82(7), 644-652.
• Blennow, K., de Leon, M. J., & Zetterberg, H. (2012). Alzheimer's disease. The Lancet, 378(9800), 2029-2039.
• Hardy, J., & Selkoe, D. J. (2002). The amyloid hypothesis of Alzheimer’s disease: Progress and problems on the road to therapeutics. Science, 297(5580), 353-356.
• Karran, E., Knapp, M., & De Strooper, B. (2011). The amyloid cascade hypothesis for Alzheimer’s disease: An appraisal for the development of therapeutics. Nature Reviews Drug Discovery, 10(9), 698-712.
• Murray, M. E., Johnson, J. E., Rollinson, S., et al. (2014). Frontotemporal dementia: A clinical review. Neurology, 82(7), 644-652.