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Intended to meet the requirements of the course LC

Complied :
Albin Salsabila Hasbi
Ayu Octifah
Jajang Andriatna
Novita Muthoharoh
Rofik Achmadi


Chapter 1

Alzheimer Case A 75-year-old white man presents for a health maintenance check-up. He denies any particular problems. A 75-year-old white man 2.The patient has stable hypertension but has not seen a physician in more than 2 years. including thyroid-stimulating hormone (TSH).(18) Admission form SURNAME : UDIN FIRSTNAME : NINGRAT AGE : 75-year-old SEX :MALE MARITAL STATUS : SINGLE OCCUPATION : PRESENT COMPLAINT : 1. Examination of the ears showed no cerumen impaction and normal tympanic membranes. Laboratory studies. having trouble with speech discrimination and understanding what family members are saying during social events (a fasia) Key words A 75-year-old white man Maintenance check-up Hypertension more than 2 years takes an aspirin and hydrochlorothiazide having trouble with speech discrimination and understanding what family members are saying during social events blood pressure was 130/80 mm Hg ears showed no cerumen including thyroid-stimulating hormone (TSH). The son reported no noticeable weakness or gait impairment. are normal . the patient’s blood pressure was 130/80 mm Hg. are normal. His general examination is normal. hypertension more than 2 years 3. He takes an aspirin a day and is compliant with his blood pressure medication (hydrochlorothiazide). On physical examination. He lives alone. His son fears that his father is either experiencing a stroke or getting Alzheimer disease because his father is having trouble with speech discrimination and understanding what family members are saying during social events.

ENT Ear Nose Throat 2. tit your head back Open your mouth I wanna check your blood pressure and pulse Are you understood what I say? Can you repeat what I say? Chapter 2 Definisi . CVS 3. CNS : : : : : I want you turn your head this way Please.O/E GENERAL CONDITION :- ENT : NORMAL RS : NORMAL CVS : GIS : NORMAL GUS : NORMAL CNS : NORMAL pressure was 130/80 mm Hg IMMEDIATE PAST HISTORY : POINTS OF NOTE : He takes an aspirin a day and hydrochlorothiazide INVESTIGATIONS : NORMAL : Alzheimer DIAGNOSIS QOESTION LIST 1.

" . Alzheimer’s gets worse over time. they must first be satisfied that there is dementia .Alzheimer’s (AHLZ-high-merz) is a disease of the brain that causes problems with memory. It involves cognitive or behavioral symptoms that show a decline from previous levels of "functioning and performing" and interfere with ability "to function at work or at usual activities.guidelines spell out what dementia consists of. or to enjoy lifelong hobbies. misplace things or have trouble with language. exercising judgment:  "Poor understanding of safety risks  Inability to manage finances  Poor decision-making ability  Inability to plan complex or sequential activities. Although symptoms can vary widely." 11 The cognitive decline is in at least TWO of the five symptom areas listed below (from guidelines jointly produced by the National Institute on Aging and the Alzheimer's Association): 11 1. are exactly the same signs that healthcare professionals look for during testing. complex tasking. Impairments to reasoning. the first problem many people notice is forgetfulness severe enough to affect their ability to function at home or at work. The disease may cause a person to become confused. lost in familiar places. For doctors to make an initial diagnosis of Alzheimer's disease. thinking and behavior. for example:  "Repetitive questions or conversations  Misplacing personal belongings  Forgetting events or appointments  Getting lost on a familiar route. Worsened ability to take in and remember new information. too. It is not a normal part of aging. Symptoms can be diagnosed at any stage of Alzheimer's dementia and the progression through the stages of the disease is monitored after an initial diagnosis. or people close to them." 2. when the developing symptoms dictate how care is managed. Signs and symptoms The information in this section connects closely to some of that about tests and diagnosis below because symptoms noticed by patients.

" 4. spelling. and expert consensus suggests that health maintenance visits should be scheduled at least every six .3. But the initial presentation can also be one of mainly language problems. these would include inability to recognize objects and faces. Treatment Treatment: Comorbid Medical Conditions When treating the Alzheimer’s Disease patient’s other chronic and acute medical conditions." 5. Finally. 11 The most common presentation marking Alzheimer's dementia is where symptoms of memory loss are the most prominent.. social withdrawal  Loss of empathy  Compulsive. Regular surveillance is necessary. by forgetting to take required medications). and writing errors. meanwhile.g. Impaired speaking. judgment and problem-solving. Once the number and severity of these example symptoms confirm dementia. Impaired visuospatial abilities (but not. 11 If visuospatial deficits are most prominent. hesitations  Speech. Changes in personality and behavior. motivation or initiative. or orient clothing to the body. due to eye sight problems):  "Inability to recognize faces or common objects or to find objects in direct view  Inability to operate simple implements. especially in the area of learning and recalling new information. the best certainty that they are because of Alzheimer's disease is given by:   A gradual onset "over months to years" rather than hours or days (the case with some other problems) A marked worsening of the individual person's normal level of cognition in particular areas. for example:  Out-of-character mood changes. obsessive or socially unacceptable behavior. including agitation. to comprehend separate parts of a scene at once (simultanagnosia). less interest. the most prominent deficits in "executive dysfunction" would be to do with reasoning. and a type of difficulty with reading text (alexia). the PCP must be aware that cognitive impairment will often have an impact on the patient’s ability to manage these conditions (e. reading and writing:  "Difficulty thinking of common words while speaking. for example. in which case the greatest symptom is struggling to find the right words. apathy. and that this impact will increase as Alzheimer’s Disease progresses.

g. 2005. and painful treatments. the goals of treatment often shift their primary focus to the relief of discomfort (see Patient and Family Education and Support section). 2003. The PCP should ensure that corrections (e.. 2007. Routine dental care is essential for the Alzheimer’s Disease patient. Recommendation: Provide appropriate treatment for comorbid medical conditions. urinary tract infection) Visual and auditory deficits are common in older adults and may further impair the patient’s selfcare abilities. Whenever new treatment plans or interventions are considered. 2000. For example. 1999). social interactions. 2000. A particular challenge with respect to tube feeding in patients with severe . the PCP must assess the patient’s (and caregiver’s) ability both to understand and to participate in the decision-making process. Finucane. “Oral health of people with dementia. Grant. Oral diseases can have a negative effect on overall health. and Expect unreported problems (e. As the patient’s dementia worsens and the ability to understand treatments and participate in medical decision-making declines.. and the potential for treatments to relieve these symptoms. hospitalization. as well as evidence that tube feeding does not necessarily prolong life or decrease suffering in severely demented patients (Alvarez-Fernández. and treatment of newly diagnosed diseases. such as diabetes and congestive heart failure. 1994). Martínez-Manzanares. specialists in geriatric dentistry should be asked to recommend special oral devices and procedures for use by caregivers (Chalmers & Pearson). & Leff. García-Ordoñez. and invasive procedures including artificial nutrition and hydration will depend upon the severity of the dementia. the treatment goals may be similar to those of otherwise healthy. reducing the risk of periodontal disease. Ouslander. Christmas.” 2006). The advisability of routine screening tests. When routine dental care becomes too challenging for Alzheimer’s Disease patients. Treatment: Palliative and End-of-Life Care In the early stages of Alzheimer’s Disease. which increases with the severity of cognitive decline (Ellefsen et al. & Travis. 2008). hearing aids) are optimal and are used properly (Grossberg & Desai. weight loss is likely to occur for a variety of reasons ranging from forgetfulness and distraction to deterioration of motor skills (Amella. Sensory deficits can affect patient performance on assessment and evaluation scales. 2003). invasive. 2008). may provide guidance in determining appropriate management. Volicer & Hurley. including review of administration and dosage of medications. as individuals with Alzheimer’s Disease have an especially high risk of tooth decay even before diagnosis.. ambulatory individuals. Routine reassessment requires that the PCP (Larson. The presence of pain or non-pain-related symptoms. as well as exacerbate symptoms of cognitive decline. Christmas. Kane.Treating patients with Alzheimer’s Disease depends upon integration of patient and family preferences with the clinician’s estimation of relative risks and benefits of the treatments under consideration. Daily oral hygiene can help prevent loss of teeth and keep gums in good repair. behavioral symptoms. or more frequently if required by the patient’s health (see Assessment section). 2005. It should be noted that current evidence argues against the use of feeding tubes in patients with severe dementia due to uncertainty about whether nutritional intake has any clinically meaningful outcomes in advanced dementia (Finucane. Hoefler. 1998): Review treatment of existing comorbid conditions. it is important to determine whether low scores are due to sensory deficits or to actual cognitive decline.g. therefore.which often requires complex. Gillick. & Gómez-Huelgas. nutritional intake. as a patient progresses from mild to severe dementia. glasses. Evaluate acute changes. & Abrass.months. and overall quality of life (Chalmers & Pearson. & Mulloy. Such goals should include management of chronic medical diseases.

. including palliative care as needed. which may result in increased confusion and a decrease in quality of life for the patient with Alzheimer’s Disease (Gillick.Alzheimer’s Disease is the tendency of confused patients topull out the feeding tube. often leading to the use of physical restraints. Hoefler). Recommendation: Provide appropriate end-of-life care.

.Chapter 3 Conclusion so A 75-year-old white man presents for a health maintenance checkup because Alzheimer.

California Workgroup on Guidelines for Alzheimer’s Disease Management Final Report 2008.2008. .journal Alzheimer Department of Public Health California Version.References No name.