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Original Question
Respond to the questions that follow Alzheimer’s/Depression Case Study Initial Presentation Patient is a 76-year-old female, alert, in no acute distress, and anxious. While shopping for groceries with her daughter, the patient became separated in the store. She became anxious, confused, and angry when store employees attempted to assist her. Daughter has brought her in, two days after the aforementioned episode. Current medications are aspirin 325 mg daily, hydrochlorothiazide 25 mg BID, Norco (hydrocodone/acetaminophen) 5/325 mg prn. T: 37 °C orally, P: 85 regular, RR: 15 regular, BP: 158/88 both arms/sitting Additional History and Family History Lives alone in a single-family home; continues to drive near her residence Recently started on prn Norco for hip pain after a fall More withdrawn from activities, told family she has not been feeling well Daughter has noticed increased anxiety and confusion in her mother on two other occasions No personal or family history of psychological illness Patient states she has some trouble with word finding, daughter confirms this Daughter noted trouble with abstract thinking, poor judgment, disorientation to place and time, and a change in mood and behavior (more withdrawn) No recent infection, no history of trauma Father and brother died of strokes with underlying heart disease; mother had Alzheimer’s disease Lab and Diagnostic Results Head CT scan showed one small capsular infarction, no mass lesion or edema, no hydrocephalus No significant abnormal results of chemistry, hematology, and metabolism panels MMSE is 18 with findings of impairment of memory and three other cognitive areas Geriatric Depression Scale (GDS) is positive for memory difficulty, disrupted sleep-wake cycle, apathy, increased dependence She will be started on an SSRI and a cholinesterase inhibitor Medication Class Alzheimer’s: Cholinesterase inhibitors Depression: SSRIs QUESTIONS What is the major cellular dysfunction contributing to the pathology of both Alzheimer’s and depression? Of the information listed in the patient history or laboratory and diagnostic results, which are typical for the pathology of both Alzheimer’s and depression? How does the identified class of medication relate to the pathophysiology of both Alzheimer’s and depression on a cellular level? Be able to discuss pharmacodynamics and pharmacokinetics. What will be observed to confirm a therapeutic response?
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