Schizophrenia Case Study Dementia

There was a 66-year-old man that presented to the clinic with his spouse. His wife stated that she was concerned because he has recently been forgetful and she stated “he zones” out. She was concerned he was beginning to display symptoms of dementia. During the visit, the patient recalled answers to questions but I could tell he became frustrated trying to remember. He stated he would get very upset because he often did not remember the task his wife would ask him to do just minutes later.

During the assessment, the patient would answer questions appropriately then often had a blank stare during questioning. At times he would answer all questions appropriate and accurately then the blank stare would return. In review of the patient’s history his spouse told me he had a history of depression, DM, and HTN. His history was negative for CHF and CVA. The patient was on Metformin, Lisinopril, and Effexor. He had no recent medication changed. In the review of systems, the patient denied all other symptoms including headache, fever, signs of UTI, signs of stroke, and all other pertinent complaints. He denies any new stressors.

I decided it was appropriate to perform the Mini mental exam to evaluate his score which was 24 out of a possible 30 points so he performed well.

We also decided to perform a urinalysis for detection of a UTI and that was also negative. The patient’s fasting CBG log was evaluated and was in the range of 100-160 which also was in normal limits. I stepped out of the room to discuss with my preceptor to determine what was the next step in his treatment plan. I discussed with her I was concerned due to the sudden onset, it occurring several times a day, and no other presenting symptoms. We decided to perform a CMP, CBC, TSH, and Hemoglobin A1C. I also spoke with her and she stated the last time this occurred in the patient there was a brain tumor and we should order a CT scan of the brain to rule this

out.

As I entered the room I discussed the urinalysis results with the patient. I also discussed that we performed the urinalysis to rule out a UTI due to the patient’s confusion. I explained that the thyroid also can cause various symptoms therefore we would also perform the TSH as well as a Complete Metabolic Panel and call the patients with the stat results. I also gave the order for the CT scan of the brain and explained we would like for him to report today for the scan and we will call with the results.

I have not returned to the clinic to review the results of the patient’s scan or lab’s. After this patient encounter, I mentioned to the preceptor I felt the patient may have some underlying neurological problem and should probably be referred to neurologist for further evaluation and she agreed. We decided we would complete the plan of care once the patient’s results were received.

As I returned to the clinic the following week to check on the results of the CT scan, I found that there was a tumor either glioblastoma or lymphoma. The patient was sent for a MRI scan and it was confirmed to be Glioblastoma of large size. The patient was called into the office to discuss the diagnosis and referred to Neurologist. This was a very sad situation.