Victor Wallace is a 74-year-old Caucasian male who was diagnosed with moderate Alzheimer disease 2 years ago. Mr. Wallace lives with his 50-year-old daughter, Anne Marie, who is his primary caretaker.

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Question 1: Mr. Wallace’s observations at the clinic correlate with the changes reported by his daughter. His daughter noticed an increase in anxiety and confusion, and Mr. Wallace was also present at her home. His language skills are declining and he uses incorrect words to describe everyday objects. He relies on scanning speech to find words, and he repeats the phrase “That’s how it is” when he cannot find the words he wants. Mr. Wallace’s agitation, sitting on the edge of his chair, tapping his foot, and rapping his hands on his knees, corresponds to the reported anxiety. Mr. Wallace’s refusal to perform ADLs and his belief that there is no point in trying because he won’t be able to do them much longer is also consistent with the changes Ms. Wallace reported.

Question 2: Mr. Wallace’s presentation prompts testing for depression because he scored high on the Cornell Scale for Depression in Dementia, indicating a high probability of depression. A common sign of depression is his decline in communication, confusion, anger, and paralysis. The nurse can further evaluate whether Mr. Wallace’s behavior is due to his dementia or if depression is also a factor.

Question 3: Mr. Wallace’s increased confusion in familiar settings is a concern for Ms. Wallace because it indicates a decline in his cognitive abilities. His increased confusion could pose a danger to his safety as he attends an adult daycare center every day. Ms. Wallace may worry about her father’s ability to remain independent and safely perform daily tasks.

Question 4: It is important to distinguish between Mr. Wallace’s refusal to perform ADLs and an inability to do so because refusal indicates a behavioral issue, while an inability is a functional issue. To address the root cause of the refusal, Mr. Wallace must first determine why he is refusing ADLs. Interventions can be made to keep him functioning or to slow down his decline if he’s unable to do ADLs.

Question 5. Speech therapy might be a suitable intervention to Mr. Wallace in order to maintain or slow down his decline in language ability. However, his decline in language may be due to his Alzheimer’s disease, and there may be limited benefits to speech therapy in these cases. Other symptoms such as anxiety or depression may also not be addressed by the therapy.

Question 6: A change in Mr. Wallace’s Alzheimer’s medication from memantine to donepezil would not necessarily affect the doctor’s choice of SSRI for depression. Both memantine and donepezil are used to treat Alzheimer’s disease, but they have different mechanisms of action. Memantine acts as an antagonist to the NMDA receptors, while donepezil works by inhibiting acetylcholinesterase. The choice of SSRI for depression would be based on the patient’s individual needs and response to treatment rather than the specific Alzheimer’s medication they are taking.

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