Question

You are a medical scribe at a neurologist’s practice and are asked to take notes during an intake assessment for a new patient. Your notes are below: Patient Name: Rob N. Willi Age: 70 years old Occupation: Lawyer, Albany NY Prior medical history: Depression (10 years prior, currently stable); Hypertension (managed with once-daily medication); Hyperlipidemia (managed with once-daily medication) No known drug allergies; Normal cardiac and kidney function Reason for visit: Rob and his wife Shelly visit with a 3-month history of sudden-onset, sporadic, and seemingly unconnected neurological complaints. Rob notes that he has been experiencing insomnia, severe panic attacks, and an annoying tremor in his left hand. He denies feeling depressed at this time. Rob has tried to control and diminish his symptoms by eating well, exercising regularly, and has recently taken up meditation and yoga practices. These have not helped, and he states “It’s like my anxiety is in a constant loop. I can’t take this stress much longer.” Shelly states that the final straw came when, during a court case, Rob was unable to recall his opening defense statement, despite having worked as a lawyer for the past 40 years and “having an excellent memory—trained actors couldn’t do better!”. The sudden loss of memory worried Rob and set off another panic attack. The neurologist plans follow-up tests for Rob in the coming weeks. Three months later, Rob and Shelly are back. Rob can no longer drive alone, and walks with a slow, shuffling gait. Rob has undergone extensive testing (spinal tap for amyloid beta protein, MRI for tumor growth, blood analysis for cortisol levels). All tests have returned with negative results. Rob states at this visit “I feel like I’m losing my mind and I can’t stop it. All I want is to somehow re-boot my brain.” He adds new symptoms to his long list: decreased sense of smell, vivid hallucinations and paranoid fears that Shelly is in trouble.

1. Based on these statements and new symptom appearance, what would you diagnose Rob with at this time? Justify your rationale (don't answer this question please. I just put it in for context.)

Lewy Body Disease

2. Are treatments available for the disorder you diagnosed Rob with? What is the expected outcome for this disorder (maintenance, progression, death, etc)? What counselling would you provide Rob and Shelly at this time? (answer this one please)

Answer 1

2. Treatments are available for the diagnosis made on the patient but it cannot be completely cured .In simple the disease progresses with out any great recovery. The symptoms can be effectively managed with the help of and the following education should be provided

• physical therapy ,to enhance muscle strength ,gait and mobility
• Medications :to improve the memory ,drugs to enhance movements ,drugs for good sleep
• Psychotherapy to treat mood problems
• Occupational therapy to do daily activities

After the diagnosis it is expected that patient survive for about five to seven years. The prognosis is poor.

The counseling required from r them ate

• To take medication as directed
• Regular follow up
• Psychological support
• Encourage them to participate in social activities
• Encourage them to explore around them in order to improve the quality of sleep being together .