Posted: May 19th, 2023

A 75-year-old male presents at your clinic accompanied by his daughter

Chronic Illness

A 75-year-old male presents at your clinic accompanied by his daughter. He states that he is going to the bathroom “a lot” and doesn’t like it. His daughter states that he sometimes doesn’t remember where the bathroom is and asks the same question several times without seeming to notice.

What diagnostic tests will you perform? What will be your plan of treatment?

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Based on the presented symptoms of increased frequency of urination and memory issues, a possible diagnostic test to consider would be a comprehensive assessment that includes:

Medical history: Gather information about the patient’s medical background, including previous diagnoses, current medications, family history of chronic illnesses, and any recent changes in health or behavior.

Physical examination: Conduct a thorough physical examination, paying attention to vital signs, neurological function, and signs of dehydration or infection.

Blood tests: Perform blood tests to assess kidney function, blood sugar levels (such as fasting blood glucose or HbA1c), electrolyte imbalances, and signs of infection.

Urinalysis: Analyze a urine sample to check for the presence of glucose, ketones, blood, and signs of infection or other abnormalities.

Cognitive assessment: Conduct a cognitive evaluation to assess memory, attention, and other cognitive functions. This can involve standardized tests or questionnaires.

Imaging studies: Depending on the findings from the initial evaluation, imaging studies such as a CT scan or MRI of the brain may be considered to evaluate for structural abnormalities or conditions like vascular dementia.

Based on the presented symptoms and the possibility of memory issues, it is important to consider the possibility of an underlying condition like dementia, which can cause both urinary symptoms and cognitive decline. Further evaluation is necessary to determine the exact cause and provide appropriate treatment.

The treatment plan will depend on the underlying diagnosis. If dementia or Alzheimer’s disease is suspected, the primary goal will be to manage symptoms, slow down the progression of the disease, and provide support for the patient and their family. This may involve:

Medications: Depending on the specific diagnosis, medications such as cholinesterase inhibitors (e.g., donepezil, rivastigmine) or memantine may be prescribed to help manage cognitive symptoms.

Behavioral interventions: Implementing strategies to help manage memory issues, such as providing visual cues, establishing routines, and ensuring a safe environment to prevent accidents.

Supportive care: Engaging the patient in activities that stimulate the mind, maintaining a healthy diet, promoting physical exercise, and providing emotional support for both the patient and their family.

Regular follow-up: Schedule regular appointments to monitor the patient’s condition, assess treatment effectiveness, and adjust the treatment plan as needed.

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