Background

The word ‘dementia’ describes a collection of several symptoms. The major symptoms include loss of memory, difficulties in thinking or concentrating, lack of problem-solving skills and difficulty in communicating or language problem. Dementia is mostly common in elderly people (Hungerford et al., 2012). The major symptoms get reflected affected late 50s and the severity increases with the age. A person with dementia may also experience sudden mood swings, throws tantrums and unrelated behaviour. Dementia, if not treated on an urgent basis may take a severe shape. However, the burden of dementia is borne not only by patient, but also by their carers, both in terms of informal and professional.

The following report provides a detailed case study of an elderly male patient who is suffering from dementia. This report follows mental state examination as a framework for documenting the signs and symptoms of the patient along with a detailed discussion of the assessment tool that can be used to treat the patient with dementia.

1.Name of the patient: Oliver Smith

Age of the patient: 60 years

Address: XXXX

Name of the report writer: XXXX

Oliver Smith is a successful architect. He is suffering from dementia. He was lately finding troubles in remembering people and objects names. However, he was continuing with his works but at times facing problem will sketching the accurate design. He slowly began to lose his ability to express innovative design. He gradually became socially withdrawn and started facing trouble while drawing sketch. While talking, he took time to express his thoughts. Friends told him that he had trouble “spitting out his words” and this generated profound frustration within him. When admitted to hospital, he was diagnosed with dementia. There was no family history of dementia. Following is the documentation of the mental state examination report of Oliver.

Smith when brought to hospital showed minimal signs of personal hygiene. There were problems with toileting habits, bathing habits and a pungent odor was coming out through his body. His appearance looked confused, somewhat loosing meaning. His dressing sense also looked disorganized. In reported cases of dementia, patient attempt to wear the same clothing every day because they forgot that they wore it the last three days in a row (Brodaty, Seeher & Gibson, 2012). When Smith was asked to remove clothes for medical test, He was found struggling with putting the clothes off. Furthermore, there was difficulty in choosing clothes that could go well together. When asked to pick up his hospital uniform, Oliver said “Give me one sweater”, although he was reported during summer. He was also comfortable with his unpleasant aroma this is due to the fact that, persons with dementia majority do not notice stains or odors on clothing (Prince et al., 2013).

Behavioral abnormalities and psychological symptoms are prominent and common symptoms of dementia (Mordoch et al., 2013). Research suggests that approximately 30% to 90% of patients suffering from dementia have chronic behavioral disorders (McCallum, & Boletsis, 2013). Oliver also showed similar kind of behavioural anomalies like depression, sudden anxiety, extreme psychosis, frequent agitation, massive aggression and insomnia/hypersomnia or sleep disturbances. There were also significant indications of bewilderment or a lack of feelings. Personality changes are most common in dementia. In case of Oliver, different aspects of personality traits became predominant like disturbing behavior, loss of personal and social awareness, decline in social interpersonal conduct and emotional blunting. Another signature behavioural symptom of dementia is memory loss (Mace, & Rabins, 2017). In case of Oliver, it was profound. He was asked about his name, he took time and fumbled and when enquired about his address he told, “I am not sure”.

Appearance

People who are suffering from dementia become extremely moody (Shively et al., 2012). Oliver was found switching between his emotions within a matter of seconds and that too for no apparent reason. In his case, there were sudden shift from elation and euphoria to extreme sadness or terror and then the immediately shifted n to another emotion. When was extremely reluctant in carrying out the medical test and was demanding desserts to eat. He then said, “please give a Chocó pie please, otherwise I may faint”. Having a Chocó pie in hospital and that too at his age is extremely unnatural. When his family members followed his instruction and brought a pie he went to a state of complete oblivion and said “who told you to bring Chocó pie, don’t you know I have diabetes”. This particular statement of his proved not only his state of memory loss, but also gave indications of mood swings.

In the domain of psychology, sensorium is regarded as the part of the consciousness (Sehgal et al., 2013). It includes special sensory perceptive powers and their correlation and integration with brain. In case of dementia, there lies a significant problem with equilibrium of sensorium. Oliver in the majority of time was experiencing lack of alertness. He do not respond on times when called by his names, showed fixed or lost glances at the horizon and was not even alter about excretion of urine.  Disorientation and bewilderment are a common symptoms of people who are suffering from dementia and Oliver was not indifferent to it. He showed very distressing and frightening signs. Oliver before admitted to hospital was in a constant mode of changing hose. He used to go and live in a special housing unit or a care home away from his own residence. Moreover, there is also an astonishing contrast to this instability. He also faced extreme difficulty to adjust to a new space at times. This is because, adjustment needs memory and learning and in case of dementia, learning and the memory are hampered most. Focusing or concentrating on a certain task was challenging in case of Oliver. Like a difficulty in making the bed, or problem with focusing on completing a puzzle and feeling uncomfortable while playing cards.

Deterioration of abstract reasoning ability in mild cognitive impairment is an important aspect of dementia. When Oliver was asked to perform an abstract reasoning test, be scored below average. There was a significant indication of decrease in the ability to analyze information, identify proper geometric patterns and relationships, and solve simple arithmetic problems on a complex or on an intangible level.  Brain scan of Oliver showed regional grey matter volume loss indicating towards loss of abstract reasoning (Wilmont et al., 2012).

Apart from a sound problem in psychological and emotional level, Oliver was physically fit. There was no reported cases of hearing loss, eye sight problem, or other nervous problems. In patient suffering from dementia, one of the most alarming problems is shivering of hands and feet. Oliver though 60 years old, showed no signs of involuntary movements of hands or feet. This provided an indication that he might be in a stage of early dementia and the neuronal anomalies have no spread its wings in a chronic level. However, following his own statement, he was tested for diabetes but was found positive. Oliver while offered Chocó pie claimed that he was suffering from diabetes but report suggests that he was not at all hyperglycemic. Now, this is case of hallucination. Oliver though hyperglycemic negative is hallucinating that he is suffering from diabetes.

Behaviour

Since his physical blood and health parameters are better than the average people of his age are, it became a bit easier for the medical health practitioner to treat him while on his stay at hospital.

2.Assessment Tools for Examination

Mini mental state examination tool

Mini mental state examination tool is a questionnaire that consists of 30 questions, which helps to measure the cognitive stage o the patients. This is mainly used to assess the condition of the patients, who are suffering from mental health illness. The patient, Oliver Smith is suffering from dementia and he is at the final stage. He needs the appropriate care with the medical treatment. The assessment tool can help to assess the severity as well as the progression of the cognitive impairment. Before taking any approach to the treatment, the condition of the patient needs to be assessed. The assessed information needs to be documented. This documented information can help in the treatment to check the difference of the cognitive stage of the patient. According to Arevalo-Rodriguez et al., (2015), the purpose of the mini mental state examination is to provide diagnosis and assess the cognitive condition of the patient. The process of the examination is quite time consuming as it has several parts. The administration of the test can take 5 to 10 minutes. On the other hand, the examination functioning includes the registration, attention, calculation as well as recall language. This can provide ability to the patient so that he can follow the simple commands and can orient accordingly. In 1975, Folstein and his mates introduced the assessment tool first (Stein et al., 2015). The tool is made to differentiate the psychiatric patients from the patients with organic patients. The questionnaire is made with some simple questions that the patients can answer.

The test has some categories, which carry some specific marks. The first category is orientation to time that carries 5 points. The other phases are orientation to place, registration, attention and calculation, recall, language, repetition, and complex commands. As mentioned by Creavin et al., (2016), if the patients scores more than or equal to 24 out of 30 then he is normal. If the score is below 9 then the condition is severe. The point in between 10 to 18 indicates moderate stage and 19 to 23 scores indicate mild cognitive impairment (Meadows et al., 2012). The score depends on the age of the patient as well. Sometimes, the results are corrected for the educational attainment. In such way, the assessment tool helps to detect the dementia. Sometimes, the physical impairment can interfere with the abnormal attainments. In such context, Van Steenoven et al., (2014) stated that some of the patients have physical problems such as hearing or eyesight problems, which affects the test results. However, the mini mental state examination tool helps to detect different types of dementia. The assessment tool is very beneficial for the treatment of the dementia. To use the tool, screening device is necessary. The cognitive impairment can indicate the need of the further evaluation. This tool helps to classify as well as helps to analyze the severity of the cognitive impairment to record the serial changes of the patient. However, the responsible nurse needs to be aware about the cut- off rate of the mini mental state examination tool test.

Mood and Affect

Another tool that can help to assess the condition of the patient is the GPCOG Screening Test. This test has two steps that are patient examination and informant interview. The two steps help to compare the condition of the patient that is the normal condition of the patient and the present condition of the patient (Julayanont et al., 2017). The full name of the assessment tool is general practitioner assessment of cognition. Brodaty in 2002 has introduced the test to assess the cognitive impairment of the patient. A screening test that is developed for the patiens is who are suffering from the dementia. It helps to provide the primary care to the patient. The first stage of the test helps to increase the predictive power of the patient. Both the parts have different cut- off scores (Paniagua & Yamada, 2013). The first stage cognitive test has several questions that include time orientation, clock drawing, numbering, spacing, place the hand correctly, recall, first name, last name, number, street, and the suburb (Comer, 2008). The second step includes six questions that are based on the past history of the patient. The total score f the test is 15. The administration of the test takes less than four minutes and the informant interview takes less than two minutes to be completed. If the patient scores nine, out of nine that means the patient does not have any mental health issues and the further steps are not made. If the score of the first step is 5 out of 9 then, it indicates serious impairment of cognitive behavior.     

GPCOG has good psychometric properties. The reliability of the test is high. The reliability of the first step is higher than the second step. The second step is satisfactory. In case of the dementia, the general practitioner assessment of cognition tool is more effective than the mini mental state examination tool. The cultural and the linguistic background do not influence the general practitioner assessment of cognition tool. The GPCOG website was introduced in 2009 that is effective for the elderly patients who cannot go to the medical centers for the physical impairment (Usher, Foster & Bullock, 2008). In such way, the physical impairment cannot affect the test result. It is easier for the nurses also to access the tool easily. Another strength of the tool is that it is found in different languages. The registration fee is free as well as no other is applicable for the test (Edward et al., 2011). The nurses should be aware about the dignity and show the respect to the elderly patient. As Oliver Smith has several problems, hence he needs to be treated with more care and respect. He has the problem of memory loss; hence, the test may take quite long time, as the nurse has to teach the procedure of the tests. The results of the tests needs to be documented for the further treatment of the patient.

Conclusion

Based on the above discussion it can be said that Smith is suffering from dementia, in which is facing various cognitive problems. His dressing sense also looked disorganized. He was found struggling with putting the clothes off. Furthermore, there was difficulty in choosing clothes that could go well together. In case of Oliver, different aspects of personality traits became predominant like disturbing behavior, loss of personal and social awareness, decline in social interpersonal conduct and emotional blunting. The assessment tools can Smith to assess the problems that is necessary for the treatment and this can help him to get well soon.

Thinking and Concentration Related Problems

References 

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