The probable diagnosis of the 67-year-old woman will be Alzheimer’s disease. Alzheimer’s is a multifactorial progressive brain cell neurodegenerative disorder that worsens over time (Weller & Budson, 2018). The presenting signs and symptoms reported by this patient’s daughter which includes extreme confusion, agitation, memory declining over the last two years, getting lost around a familiar neighborhood, problems remembering recent events and people’s names are all signs indicative of Alzheimer’s disorder. Additionally, other risk factors include feeling distrustful about others, aphasia, mood swings, hallucination, and difficulty performing spatial task depending on the severity of the disorder. The confusion, impaired reasoning and forgetfulness related to Alzheimer’s is called Alzheimer’s dementia. Some of the risk factors for Alzheimer’s are increasing age (65 years and above), family history related to genetic factors, previous head injuries, infections, neurovascular diseases, and environmental factors (Breijyeh & Karaman, 2020).
Other possible diagnosis is depression, Parkinson’s disease, delirium, and other forms of dementia. Diagnoses and treatment plan will require conducting a thorough comprehensive history and physical on the patient with focus on overall health, diet, past medical history, current medications, onset and progression of cognitive decline and family history of Alzheimer’s. Also, a psychiatric evaluation should be included in the plan to rule out depression and other mental disorders. Blood work will include CBC, CMP, and urinalysis to rule out infection, and urinary tract infection which could be causing delirium. Additionally, cerebrospinal fluid analysis will be ordered to check for increase in beta-amyloid, a protein precursor responsible for Alzheimer’s disease (Weller & Budson, 2018).
Diagnostic imaging to rule out Alzheimer’s or rule in other neurological diseases responsible for the cognitive impairment include MRI, CT, and PET scan of the brain. These imaging can disclose fluid buildup, transient stroke, benign tumors, head injuries and any structural damage that could be responsible for the change in cognition. According to Dubois et al. (2021) amyloid PET imaging is the hallmark to rule out Alzheimer’s. It is expected that the levels of beta-amyloid will form a plaque in the brain of the affected patient. There is no specific cure for Alzheimer’s now, non-pharmacological treatment plan should include exercise (both physical and mental), and healthy diet to reduce the progression of the disease. Also, pharmacological treatment should include Aducanumab, a monoclonal antibody that lower the production of the beta-amyloid protein (Dubois et al., 2021).
Breijyeh, Z., & Karaman, R. (2020). Comprehensive review on Alzheimer’s disease: causes and treatment. Molecules, 25(24), 5789.
Dubois, B., Villain, N., Frisoni, G. B., Rabinovici, G. D., Sabbagh, M., Cappa, S., … & Feldman, H. H. (2021). Clinical diagnosis of Alzheimer’s disease: recommendations of the International Working Group. The Lancet Neurology, 20(6), 484-496.
Weller, J., & Budson, A. (2018). Current understanding of Alzheimer’s disease diagnosis and treatment. F1000Research, 7.