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HAROLD B

HAROLD B. 81 Lives at home with wife She says forgetful (he says not) Always active, lately sluggish Losing interest. No significant past illnesses Remote BPH surgery, cholecystectomy MEDS occasional sildenafil F/E blurred vision, backache, constipation. O/E

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HAROLD B

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  1. HAROLD B 81 Lives at home with wife She says forgetful (he says not) Always active, lately sluggish Losing interest

  2. No significant past illnesses Remote BPH surgery, cholecystectomy MEDS occasional sildenafil F/E blurred vision, backache, constipation

  3. O/E seems a bit distant, reluctant to talk systems physical entirely negative no focal neurologic findings stands easily and walks well

  4. WHAT NEXT?

  5. Assessing Cognition • MMSE 2. Montréal Cognitive Assessment

  6. NO MORE DEMENTIA! DSM 5 has done away with the term. It’s now NEUROCOGNITIVE DISORDER

  7. DRUG TREATMENT? What do you think? If it was your parent?

  8. BETTY D 86 mild/mod Alzheimer’s lives with daughter in apartment 3x daily HSW

  9. MoCA 20 deficiencies executive, memory, orientation Comorbidity osteoarthritis aortic stenosis IBS COPD

  10. MEDS acetaminophen SR 650 BID enalapril 2.5 OD amlodipine 5 OD furosemide 20 OD donepezil 10 OD alendronate 70 Q1/52 loperamide PRN MDI corticosteroid/LABA

  11. Daughter calls: Mum has been awake at night off and on for a week. Seems more confused. Thought the dog was a raccoon.

  12. O/E pays attention poorly RR 22 no JVD 110/p sit HR 72 reg lungs clear reduced AE abdomen benign neuro unremarkable

  13. WHAT’S GOING ON?

  14. Delirium (survived the DSM5) Disorder of attention Fluctuates Thought disorder sometimes Model: alcohol intoxication

  15. COMMON CAUSES “drugs and bugs” Vascular event LESS common: “CAMP” squared

  16. CHF or dehydration (volume) CNS (imagable) Alcohol (intoxication or withdrawal) Acute abdomen (infection, obstruction, peritonitis, vascular) Metabolic (accessible to bloodwork) MEDS Pyrexia Psychological

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