Early Onset Alzheimer's: Symptoms, Diagnosis, and Treatment

1
Master in Health Care
Describe how and when symptoms emerged
The case study is of a 58 year old male patient named Sam. He complained of
progressive psychological decline which had begun 3 years before. Functioning as a
researcher, he committed calculation errors that made him leave his employment and
started filling in as a director of an organization. Be that as it may, his continuous
disturbance in ongoing memory debilitations hampered him from satisfying his
obligations, making him change occupations every now and again. Apraxia and apathy
had begun 2 years before his visit to the hospital, and unconsciousness to time and
individual was intensified to a degree which it made it difficult to drive every day
between his work and home. At the time of his visit to the facility, he had terminated his
professional activity. He also required incessant reminders from his family to look after
cleanliness and work. His sleep schedule had messed up caused him to wake up at
wee hours. He has also reported to talk to himself in the middle of the night.
Impact they have on the person’s functioning
The symptoms had left him imbalanced and unable to be accountable for the normal life
activities that he once carried on by himself. He also to leave his job and depend on his
family members and wait for them to give him cues. As a researcher he was required to
make intricate calculations and make detailed records of occurrences (Alzheimer’s,
2015). It was noticed that he made several mistakes in the calculations and unable to
manage his activities properly. The greatest impact was caused because of gradual
memory loss that made him severely bewildered as he was unable to recognise people
and even manage a healthy lifestyle. He also had diabetes and required to take
medicine for the issue but forgot to take them on time. In some cases, he administered
more doses than was necessary he was unable to keep tabs on it. As a result, his
metabolic health had also declined. His vision declined drastically and he often bumped
into furniture on his late-night activities.
Primary diagnosis
Sam has earlier visited two hospitals for a diagnosis but he was unable to receive help
that was able to manage the intensifying symptoms. In the last visit to the clinic he was
admitted to the psychiatric ward and neuropsychological test was run that showcased
severe impairment in his ability to recall something and recognition skills. Then
magnetic imaging tests were performed to see any abnormalities in the brain. Atrophy
and tissue breakdown were noticed in the medial temporal lobe and the cortes. These
were recognised as a sign of onset of dementia. In the next PET imaging test, the
presence of amyloid deposition was revealed. The above symptoms and reports from
tests suggested the onset of Alzheimer's.
Key symptoms associated with the diagnosis
The diagnosis was strengthened by the tissue breakdown noticed in the brain. However,
there were presence other physical symptoms that made the doctors run the specific
tests upon Sam. Even though Sam was able to keep his speech and verbal skills intact
he had problem in identifying people and even places that he had frequented before.

2
Master in Health Care
His eyesight has degraded drastically and he often needed to see ophthalmologist
frequently. This was one of the reasons why his family asked to consult a neurologist.
Also, the physician opted for a scan or imaging test because it clearly hinted upon
tissue degradation in the brain which can be a reason for his failing eyesight. He was
also asked to present his as well as his patient history to see some congenital patterns
that has been prevalent in their genes. However, no such experience was seen in their
family history. The neuropsychological test was run when it was seen that the physical
symptoms were common to many other mental problems. These tests assess the
activity of the brain and is able to provide an accurate diagnosis.
Bio-psycho-social formulation
Biopsychosocial formulation is a technique through which physicians gain approach an
understanding of the patient’s condition by taking into account their biological,
psychological and social perspectives of the patient’s current situation (Frisoni et al.
2017). The biological factors include genetic and developmental factors that have
shaped Sam’s life. He lived a normal life until 3 years ago when he complained of a
psychological decline. He has never experienced such a situation in his developmental
years and was always able to manage himself. There is no report of drug or alcohol
addiction that may have explained his forgetfulness and imbalanced state. He has been
facing sleep disruption which is interfering with his daily schedule. He is also unable to
use any technology like the computer software used to make calculations in his
profession and cannot drive a car. Any activity that needs Sam to perform multiple
activities and be accountable for multiple results appears to be a great task to him.
The psychological factors include Sam’s cognitive style, his conflicts, self-image and
interpretation of the symptoms (Dubois et al. 2016). Sam finds himself to be confused
and struggling to manage things all the time. He also feels tired and unable to
concentrate on things that were once easy for him. He has been very focused on trying
to adapt and manage to these changes that seeking a doctor for help did not even occur
to him. It was his family who asked him to consult someone for his failing eyesight,
which eventually led him to seek out a neurologist. His bewildered and puzzled state
makes him very vulnerable. In one such episode when Sam was roaming two blocks
away from his home because he was unable to recognise the place and find his way
back home. He also cannot be trusted to drive or use heavy machinery and kitchen
wares. Sam lives a lonely life, as a result, he has many online acquaintances. This
could also be seen as a risk as he is susceptible to being scammed for money or
personal information (Liu et al. 2015). Since he was a key part of the research team, he
is also privy to some key data that makes him a target for other competitors trying to get
ahead in their research process. Sam being unable to recognise people sometimes
latches on to unknown people and believes them to be his acquaintances. The rejection
he faces is traumatic for him and he feels lonelier than he ever was. His family has
asked him to live with them, but he is adamant on trying to maintain his independent life.

3
Master in Health Care
The social perspective of his life accounts for the social relationships he has with
people. As mentioned earlier, Sam has always led a lonely life as he was too focused
with work. His most acquaintances were either common family friends or his co-
workers, He was described to be amiable and easy-going (Olsson et al. 2016). He
attended social events whenever called to them but did not show particular interest in
them or initiated them. Sam was very focused on his research and finding a
breakthrough in it. He was unable to come to terms with the loss of his position as a
researcher but tried to adapt to his new role as a manager. However, that role also
proved to be unfit. After leaving the job, his connection to the outer world was cut. He
felt lonely, rejected and separated.
Describe the ideal evidence-based treatment
Sam was diagnosed with early onset Alzheimer’s given his symptoms were mostly
similar to those of dementia. He was admitted to the psychiatric ward and was left after
ten days of stay. The physicians believed that his treatment will focus on a way to stop
the decline of his symptoms and to preserve his psychological and cognitive ability. He
was given a 5mg of donepezil. However, the dose was increased to 23mg when it was
seen that the symptoms were still continuously declining (Liu et al. 2015). The dose was
combined with 20mg of memantine. After this the symptoms and the decline in his
ability was slowed down. They asked Sam to accept the help of care provider who
would help him to manage his activities and also keep tabs on his condition. His mother
accepted the role of his care provider and Sam moved into their home. They were
requested to make monthly visits to the clinic to ensure that his condition did not decline
further.
Donepezil is used to treat symptoms of confusion, forgetfulness and other issues that
collectively defined as dementia (Ismail et al. 2016). There is no absolute cure to
Alzheimer’s and dementia symptoms can only be decreased in their intensity to prolong
the period of time Sam is able to maintain his cognitive skills for. The drug is an enzyme
blocker that preserves the balance in the brain. Memantine is also a similar drug that
blocks glutamate which is believed to be associated with dementia symptoms. The use
of these drugs often has some side effects like dizziness, constipation, headaches and
confusion (Viola & Klein, 2015). It can also cause hypertension, acute kidney failure and
stroke in extreme cases.
Other than medication, it is essential for Sam to be prepared with what is going to come
next. There is no cure for Alzheimer’s as a result, Sam’s condition is eventually going to
decline and he has to be able to accept and adapt to it (Vossel et al. 2016). The main
aim would be to ensure the quality of life to Sam and allows him to be as independent
as possible. He needs to be protected because of his vulnerable state and ensure his
body dignity and ability to consent is maintained.
It is often seen that due to lack of social stimulus, patients with dementia often fall prey
to depression or other psychological disorders (Barnes et al. 2015). It has been noted
that there is a connection between brain activity with mood of a person which further