Scenario A 76-year -old man is brought to the primary care office by his wife wi

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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 day-time 
caregiver help him with dressing, meals and general supervision why she is at work.
Past Medical History: Gastroesophageal reflux (treated with diet); is negative for 
hypertension, hyperlipidemia, stroke or 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
Denies alcohol or recreational drug use 
Retired lawyer
Hobby: Golf at least twice a week
Review of Systems
Constitutional: Denies fatigue or insomnia
HEENT: Denies nasal congestion, rhinorrhea or sore throat.  
Chest: Denies dyspnea or coughing
Heart: Denies chest pain, chest pressure or palpitations.
Lymph: Denies lymph node swelling.
Musculoskeletal: denies falls or loss of balance; denies joint point or swelling
General Physical Exam  
Constitutional: Alert, angry but cooperative
Vital Signs: BP-128/72, T-98.6 F, P-76, RR-20
Wt. 178 lbs., Ht. 6’0″, BMI 24.1
HEENT
Head normocephalic; Pupils equal and reactive to light bilaterally; EOM’s intact
Neck/Lymph Nodes
No abnormalities noted  
Lungs 
Bilateral breath sounds clear throughout lung fields.
Heart 
S1 and S2 regular rate and rhythm, no rubs or murmurs. 
Integumentary System 
Warm, dry and intact. Nail beds pink without clubbing.  
Neurological
Deep tendon reflexes (DTRs): 2/2; muscle tone and strength 5/5; no gait 
abnormalities; sensation intact bilaterally; no aphasia
Diagnostics
Mini-Mental State Examination (MMSE): Baseline score 12 out of 30 (moderate 
dementia)
MRI: hippocampal atrophy
Based on the clinical presentation and diagnostic findings, the patient is diagnosed 
with Alzheimer’s type dementia.
Discussion Questions
Compare and contrast the pathophysiology between Alzheimer’s disease and
frontotemporal dementia.
Identify the clinical findings from the case that supports a diagnosis of Alzheimer’s
disease.  
Explain one hypothesis that explains the development of Alzheimer’s disease
Discuss the patient’s likely stage of Alzheimer’s disease.

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