SB Worsening Memory Problems

SB Worsening Memory Problems

Reason for referral:

SB is a 73-year-old, right-handed, married woman who was referred to the Healthy Brain Ageing Clinic by her geriatrician due to a 12-month history of worsening memory problems. Background:

SB struggled to provide examples of cognitive difficulties; however, her husband noted she had difficulty remembering recent information, such as events that had taken place in the past few days. Whilst she engages in conversation easily, she has difficulty remembering details from phone calls with friends and family. She has also had more difficulty learning how to use a new mobile phone and she doesn’t always know the day or date. She now requires a list to remember even a few items to buy at the store and her husband has taken over the majority of the cooking responsibilities as she forgot to turn off the oven on a couple of occasions. She continues to drive without difficulty, but only in familiar locations.

Medical history includes hypertension and hypercholesterolaemia. She was prescribed paroxetine by her GP in 2010 for a period of four years in relation to stress and worry in response to her husband being diagnosed with cancer. She has no other history of psychiatric illness or treatment. She reportedly sleeps well and is well-rested when she wakes.

SB completed year 10 of school at the age of 15. She worked as an administrative assistant for a drug company and subsequently worked in a pharmacy for more than 30 years, retiring 12 years ago. SB spends a lot of time watching television; however, she and her husband attend a weekly concert at a local club and sporting events for their grandchildren. Additionally, she occasionally volunteers to visit people from their community in the hospital when they are ill.

 Behavioural observations:

• She was well-groomed and casually dressed.
• She was cooperative and effortful throughout the session.
• Speech was normal with regard to volume, rate and prosody, but she exhibited occasional word finding difficulties.
• She frequently needed her husband to help fill in details that she could not spontaneously recall.
• Mood was euthymic. She was mildly anxious at the beginning of the assessment, but then relaxed over time.
• She exhibited limited insight into her cognitive difficulties.
• There was no evidence of distractibility or impulsivity.

 Neuropsychological data:Client Report

Kindly follow the criteria provided below.

Case presentation and history (300 words)

Provides a thorough description of the patient’s presenting symptoms/issues and any relevant additional history, co-morbidity, treatments. Includes critical as well as supportive information.

Assessment of results by cognitive domain (600 words)

-Accurately summarises all findings of neuropsychiatric, neurological, medical and clinical assessments. All relevant information presented in logical sequence and follows acceptable format. (results are expressed by interpretation; e.g. average, below average, above average)

– Draws particular attention to unusual or noteworthy results with comparison to normal values if appropriate. This is done without any diagnostic interpretation

Differential diagnosis (300 words)

-Proposes one provisional diagnosis that can explain the relevant clinical and neuropsychiatric assessment results. The rationale is explained logically with accurate reference to appropriate literature. (diagnosis is Amnestic Mild Cognitive Impairment)

-Highlights the limitations of the reported assessment techniques and the extent to which these may constrain hypothesis. Provides an integrated discussion that draws on support from the scientific literature and further demonstrates the relevance of that information to the case.

Additional investigation (500 words)

-Suggests additional assessments/investigative techniques that could better resolve the diagnostic or clinical question and shows an understanding of their relative strengths.

-Describes at least one potential finding from each of these assessments that would convincingly focus the diagnosis onto a specific disorder or answer the clinical question (e.g. capacity to make decisions)

Intervention plan (300 words)

-Recommends an appropriate intervention plan that addresses all issues raised by referring clinician, patient and family/carer (if appropriate).

– Demonstrates thorough evidence-based understanding of how such intervention strategies relate to the pathology/issues under question

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