No MMSE for You! A Case of an “Uncooperative” Patient With Early-Onset Dementia
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How do you proceed when a patient younger than 65 presents with cognitive complaints? Early-onset Alzheimer’s disease may not appear in the typical presentation that you expect from AD. Follow along with this case from experts at Banner Alzheimer’s Institute.
The Banner Alzheimer’s Institute Case Conference is a weekly event in which physicians and staff discuss challenging and/or teaching cases of patients seen at the Institute’s Stead Family Memory Clinic. These conferences are attended by a multidisciplinary group that includes Banner Alzheimer’s Institute dementia specialists, community physicians (internal medicine, family medicine, and radiology), physician assistants, social workers, nurses, medical students, residents, and fellows. The Banner Alzheimer’s Institute located in Phoenix, Arizona, has an unusually ambitious mission: to end Alzheimer’s disease without losing a generation, set a new standard of care for patients and families, and forge a model of collaboration in biomedical research. The Institute provides high-level care and treatment for patients affected by Alzheimer’s disease, dementia, and related disorders. In addition, the Institute offers extensive support services for families and many unique and rewarding research opportunities.
To cite: Tsai PH, Kaur G. Gopalakrishna G. No MMSE for you! a case of an “uncooperative” patient with early-onset dementia. Prim Care Companion CNS Disord. 2019;21(5):19alz02544.
To share: https://doi.org/10.4088/PCC.19alz02544
© Copyright 2019 Physicians Postgraduate Press, Inc.
Primary care clinicians
Implement a process using history, interview, and assessment tools for diagnosing patients suspected of having Alzheimer’s disease
Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. This special series of case reports about dementia was deemed valuable for educational purposes by the Publisher, Editor in Chief, and CME Institute staff. Activities are planned using a process that links identified needs with desired results.
After studying this article, you should be able to:
- Implement a process using history, interview, and assessment tools for diagnosing patients suspected of having Alzheimer’s disease
Statement of Need and Purpose
Clinicians are missing about half of the cases of Alzheimer’s disease (AD) and other dementias. Task-sharing and collaboration must occur between specialists and primary care physicians to address the growing number of individuals with AD. Clinicians need education on early recognition of AD using a stepwise process that includes patient observation, informant report, use of assessment tools, and additional testing or referral, when appropriate.
Release, Expiration, and Review Dates
This educational activity was published in October 2019 and is eligible for AMA PRA Category 1 Credit™ through October 31, 2021. The latest review of this material was October 2019.
Disclosure of Off-Label Usage
The authors have determined that, to the best of their knowledge, no investigational information about pharmaceutical agents that is outside US Food and Drug Administration–approved labeling has been presented in this article.
Acetaminophen/oxycodone (Percocet), gemfibrozil (Lopid).
The opinions expressed are those of the authors, not of Banner Health or Physicians Postgraduate Press, Inc.
Po-Heng Tsai, MD*
Banner Alzheimer’s Institute, and Department of Neurology, University of Arizona College of Medicine, Phoenix
Gurmehr Kaur, MD
University of Arizona College of Medicine, Phoenix
Ganesh Gopalakrishna, MD
Banner Alzheimer’s Institute, and Department of Psychiatry, University of Arizona College of Medicine, Phoenix
*Corresponding author: Po-Heng Tsai, MD, Banner Alzheimer’s Institute, 901 E Willetta St, Phoenix, AZ 85006 (Po-Heng.Tsai@bannerhealth.com).
Po-Heng Tsai, MD, is a behavioral neurologist and dementia specialist at Banner Alzheimer’s Institute and a clinical assistant professor of neurology at the University of Arizona College of Medicine, Phoenix.
Gurmehr Kaur, MD, is a second-year resident at the University of Arizona College of Medicine–Phoenix Psychiatry Residency Program at Banner Alzheimer’s Institute.
Ganesh Gopalakrishna, MD, is a geriatric psychiatrist and dementia specialist at Banner Alzheimer’s Institute and a clinical associate professor of psychiatry at the University of Arizona College of Medicine, Phoenix.
All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Larry Culpepper, MD, MPH, Editor in Chief of The Primary Care Companion for CNS Disorders, has been a consultant for Alkermes, Harmony Biosciences, Merck, Shire, Supernus, and Sunovion. No member of the CME Institute staff reported any relevant personal financial relationships.
Drs Tsai, Kaur, and Gopalakrishna have no personal affiliations or financial relationships with any commercial interest to disclose relative to this article.
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation