Reference no: EM133615111

Mr. Brown is a 72-year-old retired high school teacher who presents today with his daughter. He was referred by his primary care provider, who completed a physical assessment and found no abnormal findings. Lab studies that were faxed to your office included a comprehensive metabolic profile (CMP), a complete blood count (CBC), thyroid-stimulating hormone (TSH), and urinalysis, all of which were unremarkable.

Mr. Brown feels that his daughter is just a "worrier," but his daughter appears rather haggard and explains that her father has been getting "worse" over the past year. She stated that it began with him forgetting to pay bills or losing the car keys-things that she had attributed to normal aging. However, she reports that things are getting worse in that she has entered her father's house on a few occasions to find pans of food burning on the stove because he "forgot" that he was cooking. "One of these days, he's going to burn the house down!" she asserts. She states that she has also found dirty clothing put back into dresser drawers and has found that her father's hygiene has also deteriorated. "If I don't remind him to take a shower, he wouldn't!"

After your initial assessment, you find that Mr. Brown demonstrates impairment in at least two neurocognitive domains.

His daughter was somewhat upset at a suggestion for HIV antibody testing as she states, "My father was never a drug addict!" Additionally, she states that she is uncertain as to whether anybody in the family ever had Huntington's disease. She does know that her father had a sister who died in her 20s, but she is not sure what happened as he never spoke about it. However, she is asking you today about obtaining blood work for APOE?e4 gene testing.

During today's follow-up evaluation, you notice that Mr. Brown has some difficulty getting off the chair without assistance.

Question

• How would you address the daughter's concern about obtaining APOE e4 gene testing?
• Specific to Mr. Brown having difficulty rising from the chair without assistance, do you have any concerns? Do you think this could be related to his cognitive decline? Why or why not?
• Without doing any other diagnostic testing, what are the types of questions you might ask to rule out other types of dementia?
• What would be your next steps in the assessment of Mr. Brown?