78 year old male.
Medical History & Clinical Information
The patient is a widower, living with a caretaker 24 hours a day.
In 2003, prostate cancer treated with a radical prostatectomy surgery and subsequent radiotherapy.
No other internal pathologies and/or relevant surgeries.
The patient was evaluated at the Alzheimer’s Center in August 2006, and at that time he was diagnosed with a “possible mild Alzheimer’s disease”.
Re-evaluated in December 2007.
Cognitive and behavioral history
From the medical history information collected from the son, the cognitive-behavioral condition seems to have slightly but globally worsened compared with last year:
he is very repetitive, doesn't remember recent events, has difficulty finding objects, does not remember to take medications, doesn’t show up at appointments because he forgets them; he shows signs of confabulation (compensatory false recollections);
has maintained memories of his youth and remembers distant past more clearly;
his spontaneous language is fluent but characterized by frequent difficulties to find quickly the right words; uses a reduced vocabulary compared with the past and resorts to circumlocutions in an attempt to be more informative; has no difficulty reading and writing but has problems with calculations;
adequate use of common objects;
confuses at times the use of the telephone with that of the remote control; knows how to use electric shaver but doesn’t cook anymore;
recognizes familiar faces and doesn’t make mistakes in layering his clothes;
has difficulty in managing cash money and doesn’t handle any longer bank transactions;
he doesn’t go out by himself because he would get lost; he moves around comfortably in his own apartment;
he is disoriented in time;
hallucinations and delirious thoughts, present at the last visit, have disappeared.
From a behavioral perspective, the patient is slightly inert and apathetic. No sleep or eating abnormalities. Does not report sphincter incontinence.
Autonomy in daily functions
The patient is capable of taking care of himself but requires supervision in some basic daily activities (ex. going out, managing money, housework, etc.)
Brain CAT scan (December 2007)
No focal abnormalities with pathological characteristics in sub- and supratentorial structures.
Normal ventricular system.
Median structures in axis.
Neuropsychological evaluation (December 2007)
At an informal visit, the patient appears disoriented in time, space and autobiographical parameters. Spontaneous speech is characterized by fluent language, with normal prosody, sufficiently adequate and communicative; an occasional anomic aphasia is noted, no paraphasia or dysgrammatism; moderate deficit in the oral comprehension of the speech;
Informally: slight dysgraphia, some acalculia in simple written calculations with preservation of arithmetic rules.
On the Overall Dementia Assessment test the patient has obtained a score of 63.8/100, corrected for age and education level to 64.5/100; this score is in the medium range of cognitive pathology and indicates an actual decrease of 0.81 points per month.
The score, obtained at the evaluation session, converted through a formula developed by the Center, corresponds to a M.M.S.E. (Mini-Mental State Exam) score of 17/30 (estimated within a wide confidence band).
On the basis of medical history and psychometric information, the patient is confirmed to be suffering with a moderate degree, chronic cognitive progressive impairment of a degenerative nature, which by exclusion, is nosographically ascribable to probable Alzheimer’s disease.
Provided that the requirements set forth in the ministerial protocol are met, we believe that the patient may profit from an anti-cholinesterasic central therapy received at the out-patient facility. The aim is to begin the administration of anti-cholinesterase drugs.