What is an example of a patient with disorders of cognition and perception?

From the Guidelines

A patient with disorders of cognition and perception is likely a 75-year-old individual diagnosed with Alzheimer's disease, presenting with progressive memory loss, executive dysfunction, and visual hallucinations, as described in the most recent guidelines for the diagnostic evaluation of dementia 1. The patient's symptoms may include difficulty with short-term memory, such as repeatedly asking the same questions and forgetting recent conversations, as well as struggling with executive functioning, making it challenging to plan meals or manage finances.

• The patient may experience visual hallucinations, seeing people or objects that are not there, and sometimes misidentifying family members or familiar places.
• The medication regimen may include donepezil 10mg daily to help manage cognitive symptoms by increasing acetylcholine levels in the brain, and quetiapine 25mg as needed for severe hallucinations, though non-pharmacological approaches are preferred first 1. The care plan should emphasize maintaining a consistent daily routine, using memory aids like calendars and notes, ensuring adequate lighting to reduce visual misperceptions, and having family members gently reorient the patient when confusion occurs rather than arguing about misperceptions. These cognitive and perceptual disorders result from neurodegenerative changes in the brain, particularly affecting the hippocampus and temporal lobes, with disruption of neurotransmitter systems that regulate cognition and sensory processing, as supported by the latest research on Alzheimer's disease biomarkers 1.
• The diagnosis of probable AD dementia can be made when the patient meets criteria for dementia and has a gradual onset of symptoms over months to years, with clear-cut history of worsening of cognition by report or observation, and the initial and most prominent cognitive deficits are evident on history and examination in one of the following categories: amnestic presentation, language presentation, visuospatial presentation, or executive dysfunction 1.

From the FDA Drug Label

The diagnosis of dementia was based on the criteria stipulated under the DSM-IV category “Dementia Due To Other General Medical Condition” (code 294. 1x), but patients were not required to have a distinctive pattern of cognitive deficits as part of the dementia. Patients enrolled in the study had a MMSE score greater than or equal to 10 and less than or equal to 24 at entry. The mean age of patients participating in this trial was 72. 7 years with a range of 50–91 years.

An example patient with disorders of cognition and perception is a 72-year-old patient with mild-to-moderate dementia associated with Parkinson's disease, who has a MMSE score between 10 and 24, and meets the DSM-IV criteria for dementia due to other general medical conditions 2. Key characteristics of this patient include:

• Age: 72 years old
• Diagnosis: Mild-to-moderate dementia associated with Parkinson's disease
• MMSE score: between 10 and 24
• DSM-IV criteria: meets the criteria for dementia due to other general medical conditions

From the Research

Patient Profile

• A 75-year-old patient with a diagnosis of Alzheimer's disease, exhibiting symptoms of cognitive decline and impaired daily functioning 3, 4.
• The patient has a history of progressive memory loss, confusion, and difficulty with communication and problem-solving skills.
• Physical examination and laboratory tests have ruled out other potential causes of cognitive decline, such as vitamin deficiencies or thyroid disorders.

Cognitive and Perceptual Disorders

• The patient's cognitive function has been assessed using standardized tools, including the Mini-Mental State Examination (MMSE) and the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) 3, 5.
• Results indicate significant impairments in attention, memory, language, and executive function.
• The patient also exhibits perceptual disturbances, including visual hallucinations and misperceptions, which are common in Alzheimer's disease 4, 6.

Treatment Options

• The patient has been prescribed donepezil, a cholinesterase inhibitor, to manage symptoms of cognitive decline and improve daily functioning 3, 7.
• Alternative treatment options, such as rivastigmine and galantamine, have also been considered, but donepezil has been chosen due to its established efficacy and safety profile 5, 7.
• The patient's response to treatment will be closely monitored, with regular assessments of cognitive function and daily functioning to adjust the treatment plan as needed 6, 5.