Case Study

Gregory Kelly
100380244
September 28, 2018
Laura Maybury

Background about Alzheimer’s

Alzheimer’s is a type of dementia that causes problems with memory, thinking and behaviour
(Alzheimer’s Association, 2018). The symptoms develop slowly and progressively get worse as
the person gets older (Alzheimer’s Association, 2018). It usually affects people older than 65
years old. It is the most common form of dementia and accounts for 60-80% of dementia cases
(Alzheimer’s Association, 2018). The greatest known risk factor is getting older but it is still
possible to get it before the age of 65 which is called early onset Alzheimer’s (Alzheimer’s
Association, 2018). The cause of early onset Alzheimer’s is unknown but some scientist have
pinpointed several rare genes that directly cause Alzheimer’s (Alzheimer’s Association, 2018).
People who inherit these genes tend to develop symptoms in their 30s, 40s and 50s (Alzheimer’s
Association, 2018). Alzheimer’s Association says that “when Alzheimer’s is caused by
deterministic genes it is called “familial Alzheimer’s disease” and many family members in
multiple generations are affected”. Scientist believe two proteins damage and kill nerve cells
(Johns Hopkins Medicine, n.d.). The build up of fragments of the protein beta-amyloid are called
plaques and the twisted fibers of a protein called tau are called tangles (Johns Hopkins Medicine,
n.d.). People naturally develop plaques and tangles as they get older but in alzheimer’s they
develop a lot more than average which damage the memory area of the brain (Johns Hopkins
Medicine, n.d.). Research suggest that synaptic loss and defective neurogenesis are related to the
accumulation of alpha beta oligomers rather than fibrils (Crews and Masliah, 2010). The alpha
beta oligomer may lead to synaptic damage by forming pores which alter synaptic plasticity,
neuronal cell and neurogenesis (Crews and Masliah, 2010). It is difficult to diagnose early onset
Alzheimer’s because symptoms are similar to stress and depression which results in getting
conflicting diagnosis (Alzheimer’s Association, 2018). There are 3 stages of this disease which
are early, middle, and late and people who have it can be in any of the 3 stages (Alzheimer’s
Association, 2018). The middle stage is the longest stage that can last for years (Alzheimer’s
Association, 2018). There is no cure for Alzheimer’s and as stated before it is a progressive
degenerative disease (Alzheimer’s Association, 2018).

Case
Kaitlyn is a 42 year old who works in payroll in a trucking company. She is married to a man
named Joseph and has a girl named Mya and a boy named Marcus (13 and 9 years old
respectively). Kaitlyn liked to stay active by playing sports such as volleyball with friends once a
week, and golfing with her husband Joseph before symptoms began to develop. The family
started to notice that Kaitlyn would stop mid sentence and have problems finding the right word
she wanted to say. She would also repeat questions that were answered not to long before and
misplace things and blame other people and get very frustrated when she couldn’t find them.
Joseph also noticed that she would become overwhelmed and confused while she would be
cooking dinner or baking and has burnt some food while unsupervised. Kaitlyn mentioned before
that her grandmother had Alzheimer’s to her husband. They went to see a doctor and was
initially told her symptoms were from stress but a year later was diagnosed with early/young
onset alzheimer's. She was diagnosed to be in the early stages of the disease. Kaitlyn slowly
began to decrease the amount of times she would go out with her friends to play volleyball,
golfing with her husband and other social events because of the stigma of Alzheimer’s being an
old person’s disease. Kaitlyn has reduced her hours at work but still finds it difficult to keep up
with her job due to feeling overwhelmed sometimes. On days where Kaitlyn is having a bad day
she may become flustered and angry when she can’t remember a lot of things. When she
becomes flustered and angry at tasks she is trying to perform she needs to take a mini break from
said activity and take a couple deep breaths to help her calm down and re approach the task or
ask for help is necessary. If she ask a question more than once and you say “you already asked
that question” she becomes embarrassed and depressed as she may believe the person will think
she is dumb or not truly listening to them talk. Just answer the question again and continue with
the conversation.

Medication
Initially she was prescribed prozac to deal with stress and she took that for 1 year and after she
was diagnosed with early onset alzheimer’s she started taking Donepezil (Alzheimer’s
Association, 2018) once a day before bed within the last 3 months to help slow down the
progression of the disease and stopped taking prozac. The side effects of Donepezil include
nausea, vomiting, loss of appetite increased frequency of bowel movements, weakness,
drowsiness, dizziness and trouble sleeping (Alzheimer’s Association, 2018 & Rogers S. et al.,
1998). Sometimes Kaitlyn has problems sleeping so she takes a diphenhydramine (Zzzquil).

ICF model

Condition:
● Alzheimer’s (early onset, early stage)
Body Functions and Structures: (Alzheimer’s Association, 2018)
● Cognitive impairments
● Synaptic damage
● Neuronal loss
Activities:
● Carrying and participating in conversation
● Cooking
● Keeping track of things
Participation:
● doesn’t go out to play volleyball with friends because lack of confidence
● doesn’t go out for social events with friends
● being a mother by preparing meals for the family
 ● Difficult to make new friends or learn the name of new colleagues
● Difficulty keeping up with her job in payroll
Environmental Factors:
● 2 floor house
● Lives in the suburb
Personal Factors:
● 42 years old
● female
● mother of 2
● married

Treatment (Lohsdon R., et al., 2007)

The treatment will focus on cooking skills because by improving/maintaining this it will build
her confidence and give her independence. Since Alzheimer’s is a progressive degenerative
disease we will work on compensatory strategies for Kaitlyn to use while cooking (Lohsdon R.,
et al., 2007). Cooking will be made simpler by using prepared ingredients and not cause Kaitlyn
to feel overwhelmed during this task. The treatment will be carried out in her home so she can
become accustomed to her environment (kitchen). If possible Joseph should be present during
the session so her can see in which areas she has problems and knows how to help her. Kaitlyn
will prepare fried egg with cheese and chicken in it.

Equipment needed:
● poster with pictures of steps in meal preparation
● Grated cheese
● Cut up grilled chicken
● Egg white in carton
● Bowl
● microwave
● Timer
● Recipe

There will be a poster with pictures of each step in order posted by the stove for Kaitlyn to refer
to in case she forgets what to do next.
 1. A recipe will be given to Kaitlyn with pictures and names of the ingredients at the
top of it.
2. Together with Kaitlyn, each step will be talked through.
3. After running through the steps one time, we will go through each step again but
perform the actions of each step at the same time ensuring to let her know of safe
precautions. *let Kaitlyn try to explain each step first before correcting her if
necessary*. 25 minutes
4. Talk through the process on the poster to ensure she understands what each step is
and understands the safety precautions. 5 minutes

Safety precautions:
● Eggs will be cooked in the microwave which eliminates the use of a frying pan which she
could burn herself on.
● Ensure she inputs the correct cooking time on the microwave
Results observed in each treatment session is recorded electronically on a soap note and shared
with other members of Kaitlyn’s health care team via double password secured database.

Community resources
● Alzheimer Society Durham region http://alzheimer.ca/en/durham

References

Alzheimer’s Association (2018). What is Alzheimer’s?. Retrieved from

https://www.alz.org/alzheimers-dementia/what-is-alzheimers .
Crews L., and Masliah E. (2010). Molecular Mechanism of Neurodegeneration in Alzheimer’s
Disease. Oxford Journals Human Molecular Genetics. Vol 19(1) pg. 12-20. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875049/ .

Johns Hopkins Medicine (n.d.). Early- Onset Alzheimer’s Disease. Retrieved from
https://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/early-
onset_alzheimers_disease_134,63 .

Logsdon R.G., McCurry S.M., and Teri L. (2007). Evidence-Based Interventions to Improve
Quality of Life for Individuals with Dementia. Alzheimer Care Today. Vol 8(4) pg. 309-318.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585781/ .

Rogers S.L., Doody R.S., Mohs R.C., and Friedhoff L.T. (1998). Donepezil Improves Cognition
and Global Function in Alzheimer Disease. Archives of Internal Medicine. Vol 158 pg.1021-
1031. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/205223 .

Bullet Rounds for Kaitlyn

● 42 year old Female with early onset Alzheimer’s in the early stages
● Married and mother to 2 kids
● Alzheimer’s is a progressive degenerative disease
● Problems finding the right words to say sometimes
● places things down and forgets where she put them
● She likes to stay active
● Gets overwhelmed when things aren’t organized or she has lot to think about at once
● When she feels overwhelmed she needs to take a mini break and take a deep breath
before starting again
● If the client says something that is untrue do not argue with them about it
● Only help client with finding the right word if she asks for assistance
● Takes donepezil at night before she goes to sleep
● Uses Zzzquil occasionally when she has problems sleeping
● If she seems stuck during treatment give her time before giving her the answer
● Her husband provides most of her care at home and will be present during treatment
session
● Since client has burnt food before, stove use will be avoided if possible
● Ensure the correct cooking time is input into the microwave
● Clutter can cause her to feel overwhelmed
● When talking through steps ensure the client truly understands before moving on
● Provide encouragement when she gets stuck
● If it helps, she can work through preparation with her husband and you ensure
everything is going correctly
● Ask if there is anything she would like to try and make in a future session