Case Studies: Neurocognitive Disorders

Learning Objectives

  • Identify neurological disorders in case studies

Case Study: Sarah

Sarah is a 78-year-old female and is very outspoken. Sarah has been an actor in off Broadway shows as well as working as a consultant in the education industry for 30 years prior to retirement. Sarah and her family members over the past year have noticed that she is not remembering things as well. Sarah even admitted to her husband that she is more and more having forgetful moments over the past two years. Sarah’s mother and aunt were diagnosed with a neurocognitive disorder several years before they passed away. Sarah agreed to go to the doctor and was a bit worried about the biological impact of her mother’s disorder, but kept an open mind. Sarah went to the doctor and discussed what was going on, and the doctor referred Sarah to specialists who focus on memory. Sarah was asked if she partook in any substances, which she said she occasionally has wine to drink to unwind some evenings, but nothing problematic. Sarah was administered several memory tasks and the doctor said the results were OK, as she remembered two out of four items and said that he wanted to see her again in three months.

Sarah went back in three months and there was no change, but at six months she was only able to remember one out of four items on a memory task and he suggested starting treatment. Sarah was administered an acetylcholine agent that could help limit memory loss for a period of time. Over the next three years, Sarah remained with mild cognitive loss, but after three years on the medication, the effectiveness was not showing, unfortunately. Sarah was then told that she needed permanent care as her memory was progressing at a negative rate. Sarah was at home for another three years, but then was unable take care of herself and was put in a nursing home facility.

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An elderly woman sitting alone.

Figure 1. Gina has seen a decline in her desire to participate in her usual activities alongside a decline in cognitive abilities.

Case Study: Gina

Gina is 76 years old and went to her doctor for a regular physical as she did each year. Gina told the physician that she recently has socially isolated herself and has not felt comfortable visiting and spending time with family. Gina also was having hallucinations and found that she had symptoms that were consistent with Parkinson’s disease, but was not sure. Gina also told the physician that she seems to forget things a great deal more than she used to and wanted to find out why. Gina also discussed with her doctor that her alertness and attention varied quite heavily. Gina said her family members have said that they noticed a 20–25% decrease in her cognition over the past six months. Gina discussed as well that she is not as active as she was six months ago, and sometimes she does not have the energy to go outside and go for a walk as she has done in the past. Gina took part of a memory task at the physician and was only unable to recall one out of four items that the doctor presented to remember. Gina’s doctor suggested that she receive an opinion from a specialist and referred her to them.

Think it Over

What are the treatment options that could be part of the process in helping Gina and why? Also, if you were the physician, which specialist or specialists would you refer Gina to and why? What tests/exams should Gina have in relation to further diagnosis?

Also, in Sarah’s case, do you feel going to the doctor helped her cause in relation to memory loss and if so why? What treatment would you focus on for Sarah and why?

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