Please respond to discussion below using current APA edition and 2 scholarly references. Must be at least 150 words.
My clinical experience for this week continued to be rewarding and challenging as well. The patient I encountered this week had neurological problems, particularly related to a decline in cognition and mobility. This encounter was an excellent opportunity to gain hands-on experience in the evaluation and management of neurological conditions in older adults. One challenge I faced was to accurately determine the cognitive decline of the patient who was unwilling to engage in some aspects of evaluation and cognitive tests. This is common in older adults who often describe cognitive tests as embarrassing, stressful, and bewildering (Wong & Jacova, 2019). Nevertheless, success was achieved by establishing rapport and trust with the patient, which enabled a more complete evaluation.
The patient was a 68-year-old Caucasian female who displayed symptoms of cognitive impairment, difficulty with coordination and balance, and decline in mobility. She had a 2-year history of progressive cognitive decline that started as difficulties recalling recent events and information, learning new tasks, and sustaining attention. She reported that she had retired from employment as an administrative assistant 10 years ago, not because of cognitive challenges but because family finances allowed it. Her past medical history was remarkable for type 2 diabetes and hypertension, both diagnosed 4 years ago and are well-controlled with medications and lifestyle modifications. There was no significant surgical history or family history. She had no history of alcohol, smoking, or other drug use, abuse, or misuse.
The evaluation consisted of a thorough review of medical history, cognitive screening tests, neurological tests, and gait assessment. An initial clinical review revealed that the patient had increasingly withdrawn from the closest people she had, including family members and friends. Neurocognitive assessment revealed an MMSE score of 14/30, poor visuospatial and executive skills, as well as poor verbal fluency. Her speech was fluent without semantic deficits, and her neurological exam was pertinent for normal muscle power and tone, normal gait, and mild ideomotor apraxia. Her general physical exam was insignificant, and her vital signs were normal and stable: BP of 116/70 mmHg, RR of 18/min, HR of 93/min, temp of 98.6oF, BMI of 24.0, and pain of 0/10. MRI and EEG had revealed mild temporal atrophy and bitemporal slowing, respectively, during her previous consultation with a neurologist.
The Core differential diagnoses that were considered included Alzheimers disease (AD), normal pressure hydrocephalus, and vascular dementia. Based on the progressive memory problem and cognitive decline, along with the MMSE score and the previous MRI and EEG findings, AD was suspected (Atri, 2019). The plan of care for the patient included further diagnostic evaluation including MRI and CT scan of the brain, laboratory tests with the aim of excluding other reversible causes of cognitive decline, and referral to a neurologist for specialized assessment and implementation of the interventions to optimize cognitive function and mobility. The health promotion measure that we addressed with this patient was a personalized exercise program based on her abilities and preferences to enhance mobility and balance.
In conclusion, this weeks clinical experience was another excellent learning and rewarding opportunity. From this clinical practice, I realized the significant role that a holistic assessment plays in the diagnosis and management of neurological disorders in the elderly. The research guidelines proposed by the American Academy of Neurology underline the importance of early diagnosis, multidisciplinary team cooperation, and personalized interventions.
