Differential Diagnosis
The differential diagnosis presented in this paper will be based on the case study of Fred. This patient is in his late 60s and has reportedly been experiencing problems with memory and overall cognitive functioning. The patient and his wife have revealed that the patient is having issues of memory loss, language impairment, difficulty performing basic tasks, such as driving, misplacing objects, delusions, agitation, and depression. While the patient is being given a provisional diagnosis of a major neurocognitive disorder due to the late onset of Alzheimer’s Disease (AD), it is imperative to look at other possible reasons/causes for the patient’s reported issues and symptoms.
In terms of a differential diagnosis, the patient’s symptoms can be attributed to disorders of major depressive disorder, dementia or Alzheimer’s, possible stroke, or simply the natural progression of aging. Each of these must be considered carefully in order to come to a sound and valid diagnosis. Further, though it is possible that the patient is suffering from any of the aforementioned conditions, it is extremely likely that the patient is dealing with AD due to his prevailing symptoms. These symptoms include the substantial diminishment and impairment in memory and learning processes, language ability, and the patient’s inability to perform basic everyday tasks. Such symptoms and observed behaviors are consistent with diagnosis of AD in the DSM-5 diagnostic manual.
The patient’s issues have been taking place over the estimated course of eight years and instead of improving, they have only become more severe, debilitating, and progressive through the years. There is no history of major medical issues prior to the onset of the patient’s symptoms, no substance use history, etc. Moreover, as maintained in the Diagnostic and Statistical Manual, Fifth edition (DSM-5):
At the mild NCD phase, Alzheimer’s disease manifests typically with impairment in memory and learning, sometimes accompanied by deficits in executive function. At the major NCD phase, visuoconstructional /perceptual-motor ability and language will also be impaired, particularly when the NCD is moderate to severe (APA, 2013, section 2).
We can see that the patient meets all of the above criteria for AD just by reviewing his symptoms. Knowing this, and taking into consideration how long the problems have been occurring, it is crucial to ask what sort of treatments/interventions would be beneficial to the patient at this seemingly progressive stage in his disorder.
Although there is no cure, there are both evidence-based and non-evidence-based treatments for Alzheimer’s disease. The evidence-based treatments are typically designed to slow down the progression of the disease by protecting the brain from neurodegeneration. Evidence-based treatment for AD include five main interventions: “cholinesterase inhibitors (ChEIs), memantine, antipsychotic agents, antioxidants, and ginkgo biloba” (Vardi, 2010, p. 1). The well-established treatments for AD, such as cholinesterase inhibitors, memantine, and antioxidants work to provide symptomatic relief from cognitive and functional symptoms, whereas ginkgo biloba works to help with behavioral symptoms (Vardi, 2010). As previously stated, while there is no cure for AD, interventions such as these can slow its overall progression. Non-evidence-based interventions like exercise, increased social interactions and cognitive stimulation may be beneficial for patients with Alzheimer’s disease (Howe, 2009); however, they are not without the possibility of adverse responses, such as false hope. Non-evidence-based interventions may not stop the progression of degeneration, but they could improve a patient’s emotional and physical state to such a degree that their symptoms become less burdensome and problematic.
With North America being a multicultural nation, it can be a bit difficult to explicate the sociocultural perspective(s) of Alzheimer’s disease. In fact, this is a disease that is highly subjective in terms of experiences (Disman, 1991). Typically, it is minorities and older populations who are most at risk of developing this condition; however, this is not a disease that largely discriminates against demographics. Nevertheless, there is a crucial need for more research into sociocultural variations of subjective experiences of/with this disease.
Finally, AD is primarily reviewed from a biological/genetic perspective and orientation, this is essentially because there does not appear to be any other cause for it. It is not a condition that is a product of repressed emotions and experiences (psychodynamic/psychoanalytic lens), it is not something that is learned through conditioning and/or observation (behavioral lens), nor is it a product of failing to achieve self-actualization (humanistic lens). Though the cognitive perspective could ultimately provide insight into what areas of the brain are being impacted through a patient’s external manifestations of behavior, biological and genetic components appear to be the primary go-to when conceptualizing Alzheimer’s disease.
References
American Psychological Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
Disman, M. (1991). The subjective experience of Alzheimer’s disease: A sociocultural perspective. American Journal of Alzheimer's Disease & Other Dementiasr, Vol 6 (3), pp. 30-34. Doi: 10.1177/153331759100600306
Howe, E. (2009). Using nonevidence-based approaches to treat patients with Alzheimer's disease. Psychiatry (1550-5952), 6(3), 18-23.
Vardi, L. (2010). Alzheimer's disease: evaluation of the effectiveness of currently used pharmacological treatments: critical appraisal of the literature on evidence based effectiveness of pharmacological treatments in Alzheimer's disease. New Zealand Medical Student Journal (Online).
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