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Week 5 CSL notes- Alice Determan

Key information:

 Presenting problem
o Confusion- worse in past 6 month
o Forgetful- forgets daughter and husband’s death 10 years ago- distressed
o Behavioural changes- found wandering outside of house
o Mismatching buttons, odd shoes
o Boil electric kettle
o Searching behaviour
o Glasses in sugar
o Frozen peas in bowl on bench
o No signs of injury
o delusional

 Past medical history


o
 Medications
o Flu shot 1 month ago
 Family history
o
 Social history
o Lives alone and daughter visits every week (capable of looking after herself in
past)
o House unusually dirty

Confused/ behavioural change


 Trauma
 Alzheimer’s disease
 Diabetes
 Medications
 Infections- UTI
 Vascular damage
 Dementia
 Tumour
 Delirium
 Epilepsy
 Shock (septic)
 Sleep deprived
o Stress
o Medication
o Age
o Delirium
o Pain
o Anxiety
o Body dysfunction
o Dietary
o Nocturia
o Hormonal issue (cortisol, hyperthyroidism)

Forgetful
 Alzheimer’s disease
 Dementia
 Delirium
 Tumour
 Medications
 Trauma
 Vascular disease
 Lack of sleep
 Stress
 Hormonal issues (cortisol)

Delusional
 Medications
 Psychosis (Schizophrenia, Bipolar)
 Infection
 Delirium
 Sleep deprivation

Further information
 What medications?
 Any family history of similar conditions? (psychosis, dementia)
 Any fever or infections? (headaches, anorexia, dietary, neck stiffness)
 Falls or trauma that daughter might not know about?
 Difficulties urinating?
 Where are family from?
 Contacts
 Vaccinations
 Alcohol
 Smoking
 Drugs

Further history obtained


 Suspected dementia 6 months ago
 Mild urinary urge incontinence for last 3 years
 23/30 on SMMSE
 Normal CT with aging
 Vaccinations up to date
 No medications other than Panadol and multi vit
 Pretty good social life
 Daughter is enduring and medical power of attorney

Further information by examination


 SMMSE
 Vital signs
 Neurological exam (CN peripheral sensory and motor)
 Cardio exam
 Respiratory exam
 Carotid bruits
 Endocrine exam
 Weight changes- hormones and possibly a very fast tumour (probs not)
 Gastro, abdominal exam

Key info from examination


 Visual hallucinations
 Wetting herself and doesn’t smell healthy
 Dry tongue from dehydration
 Restless and agitated
 Drowsy at end of exam
 Blood pressure systolic change of 20 and diastolic of 15 and this is abnormal
(postural hypotension) dehydration
 Increased HR, RR, Temp
 Primitive reflexes- decline in brain function
 SMMSE 14/30- abnormal drop and too steep to say its dementia

Alice Determan 85yo female

Dementia (6 months ago) => Mild cortical atrophy (age)


Learning issues

 Different types of dementia focus of Alzheimer’s


o How is it determined/diagnosed, signs, symptoms, prognosis, epidemiology
 Difference between dementia and delirium
o Definition and mechanism of common causes
 SMMSE 25-30=normal
 Urge vs Stress Incontinence (understand normal continence and micturition reflex)
 Primitive reflex- look at what the reflexes are and what they test for