PSYCHOLOGY: Case Study Analysis
Diagnosis
Betty is in the mild to moderate stages of Alzheimer’s disease as can be seen by problems with word-finding, impaired reasoning, and judgement. The mild version of the disease is typically characterised by memory loss, wandering and getting lost, taking longer than normal to complete common daily tasks, and trouble handling money or paying bills. For some people, memory loss is greater than for others, while in some it is also accompanied by other cognitive difficulties including spatial or vision problems. Personality and behaviour changes are also commonly seen in the mild stages of Alzheimer’s, which gradually progresses to language control issues, as well as increasing memory loss and confusion.
This diagnosis is based on the symptoms she has exhibited starting with her tendency to focus on long ago events during her growing up ages while losing focus on the present train of thoughts ("Alzheimer's Disease & Dementia | Alzheimer's Association", 2017). Her confusion following her wandering off at the train station was the first noticeable symptom of her ailment. Her supervisor also observed that she had forgotten to handle both her computer and her telephone, yet Betty herself kept giving lame excuses for the occurrences ("Alzheimer's Disease Fact Sheet", 2017). Her inability to recognise familiar words and their meaning point towards language control issues. The complaints from visitors to the company on her spoken language also support this finding ("Alzheimer's Disease & Dementia | Alzheimer's Association", 2017).
Theories of causation
While the reason the causes that may trigger Alzheimer’s is not yet completely understood, the late-onset Alzheimer’s that has affected Betty is assumed to have occurred from a complex series of brain changes that occurred over decades. The causes of the disease in Betty may be a combination of lifestyle, environmental and genetic factors ("Alzheimer's Disease Fact Sheet", 2017). The possibility of accurately determining the causes would only be possible upon her death. Scientists feel that age-related changes including the shrinking of brain cells, also called atrophy, mitochondrial dysfunction which is the breakdown of energy production within the cell, and the production of free radicals or inflammation may be the causes that have triggered the late-onset Alzheimer’s in Betty by harming the neurons in her brains ("Alzheimer's Disease: Causes, Symptoms and Treatments", 2017).
Late-onset Alzheimer’s is seen to typically manifest itself in the early to mid-60s, and genetically the Apolipoprotein E(APOE) in the form APOE ε4 increases the probability of triggering the disease, although there are cases of persons without this problem also exhibiting Late-onset Alzheimer’s Disease. Brain scans like MRI, CT or PET would have to be performed to determine the extent of progression of the disease. simple memory tests, attention tests, as well as tests related to problem-solving, language, and counting would need to be periodically conducted besides the standard blood and urine tests to determine the exact causes that have triggered the disease in Betty.
Oftentimes, lifestyle, health, and environmental factors may have been responsible for triggering Late-onset Alzheimer’s disease. Questioning friends and family on topics like overall health, changes in behaviour and personality, ability to carry out daily tasks, and past medical problems is also one method of identifying the triggers ("Alzheimer's Disease: Causes, Symptoms and Treatments", 2017). However, the surface facts point towards a genetic factor that may have been the primary trigger for Betty. Her mother was “senile” and lived in a care home while her father had died of a stroke. Thus the genes that may have triggered Late-onset Alzheimer’s seem to be part of Betty’s DNA and this needs to be explored further (Goldman et al., 2011). The level of progression also needs to be identified as she is unable to function without assistance from her co-workers and Herbert, her boyfriend.
As the disease progresses, Betty would have problems recognising family and friends, and exhibit an inability to learn new things and cope with new situations. The multiple steps involved in getting dressed would be problematic for her and may start behaving impulsively. She would be prone to delusions, paranoia, and hallucinations as well with the further shrinking of her brain tissues. Betty’s tendency to forget appointments and events as well as her inability to manage finances, social withdrawal, and out-of-character mood changes are marked traits of probable Alzheimer’s dementia. Since Betty has not had any major physical, psychiatric, or mental health problems, the most probable cause for Betty’s diagnosis verges towards genetical factors.
Treatment plan
The disease is irreversible and progressive regardless of its causation. Since the causation has been identified as being more due to genetic factors, there is no particular treatment for the causes ("What Is Your Risk?—Heredity and Late-Onset Alzheimer’s Disease", 2017). The treatment plan would therefore focus on Dementia Care Plan. The care plan would address factors like patient biography, mobility, eating patterns, recreational activities, toileting, communication, orientation, behavioural and psychosocial patterns, cognition, and caregiver support needs. as her disease progresses ("Developing a Dementia Care Plan", 2017), Betty would need more care and may even have to be admitted into a long-term care home or adult day care setting which offer skilled nursing care. There needs to be a constant and ongoing collaboration between the resident, the family, and the care team to ensure adequate care and support for the patient ("Alzheimer's Disease & Dementia | Alzheimer's Association", 2017).
The Dementia Care Plan recommended for Betty would focus on a more personal account of Betty as a person both earlier (before the onset of the disease) and now. While newer drugs and medication are constantly entering the market there is no cure for Alzheimer’s at present. Betty as well as her near and near ones need to be part of the planning process to ensure that all are aware of the manner in which the disease will progress ("Developing a Dementia Care Plan", 2017). Furthermore, she needs to carefully make plans for her future including financial arrangements. The most important aspect of the treatment plan is that Betty must accept the problems being caused by the disease while realising that it is not her fault. As long as she continues to deny her disease, it would be difficult to help her face reality. She needs to actively be involved in the planning process to ensure that she is able to ensure a dignified life even after her disease progresses to acute levels where she is unaware of what is happening.
References
Alzheimer's Disease & Dementia | Alzheimer's Association. (2017). Alz.org.
Alzheimer's Disease Fact Sheet. (2017). National Institute on Aging.
Alzheimer's Disease: Causes, Symptoms and Treatments. (2017). Medical News Today.
Developing a Dementia Care Plan. (2017). BrightFocus Foundation.
Goldman, J., Hahn, S., Catania, J., Larusse-Eckert, S., Butson, M., & Rumbaugh, M. et al. (2011). Genetic counseling and testing for Alzheimer disease: Joint practice guidelines of the American College of Medical Genetics and the National Society of Genetic Counselors. Genetics In Medicine, 13(6), 597-605.
What Is Your Risk?—Heredity and Late-Onset Alzheimer’s Disease. (2017). BrightFocus Foundation.
