Posted: September 8th, 2023

In the presented case of a 75-year-old male experiencing frequent bathroom

In the presented case of a 75-year-old male experiencing frequent bathroom visits and memory lapses, a comprehensive diagnostic approach is essential to determine the underlying cause of his symptoms. Given the daughter’s concern about memory issues, one possible concern is the presence of early Alzheimer’s disease or another form of cognitive impairment.

In this case, it is imperative to conduct a more comprehensive assessment due to the concerning findings that may suggest early-stage Alzheimer’s disease as a potential underlying cause. The patient has reported a notable increase in bathroom visits, which raises initial concerns about urinary issues. However, the daughter’s observation of the patient’s occasional inability to remember the bathroom’s location and the repetition of inquiries about it adds a layer of complexity to the clinical presentation.

In light of these observations, it is essential to consider the possibility of cognitive impairment or dementia. To elucidate the nature and extent of these cognitive deficits, I will proceed with a comprehensive cognitive and functional assessment. This assessment will include standardized cognitive screening tests to evaluate memory, reasoning, and executive function. Moreover, I will closely observe the patient’s capacity to carry out essential daily tasks, including independent use of the bathroom.

To reach a diagnosis and establish an appropriate treatment plan, several diagnostic tests and assessments should be considered:

First test that we should consider is to administer a standardized cognitive screening test, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA), to evaluate the patient’s cognitive function.

According to (Gallegos et al., 2022), the MMSE, is a test that has become one of the most widely used internationally for the diagnosis and clinical prognosis of cognitive impairment, mainly in elderly patients.

Patient is going to need a detailed medical history, including the onset and progression of symptoms, any relevant family history of cognitive disorders, and any other concurrent medical conditions as well as a detailed physical and neurological examination to assess his overall health.

Blood tests such as a Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), and an urinalysis should be performed to eliminate the possibility of a Urinary Tract Infection (UTI) or diabetes as contributing factors. UTIs can sometimes lead to confusion, while diabetes may lead to increased frequency of urination.

To gain deeper insights into the patient’s behavior, a careful and continuous monitoring approach is warranted. Specifically, it may be beneficial to closely observe the patient when he goes to the bathroom. This monitoring can help distinguish whether the increased bathroom visits are due to genuine physiological needs or if they are manifestations of repetitive behaviors associated with cognitive impairment. Such meticulous observation is critical for making an accurate differential diagnosis, as it may shed light on whether the patient’s symptoms are primarily related to a cognitive disorder, a urological issue, or a combination of both.

Diagnosis: Early Alzheimer’s Disease

While there is currently no known cure for Alzheimer’s disease, treatment strategies aim to manage symptoms and slow down its progression. The following interventions are recommended:

1. Medication:

Galantamine 8 milligrams (mg) once daily, following the dosage guidelines outlined in Mayo Clinic’s recommendations. This medication is prescribed to enhance cognitive function and alleviate some of the symptoms associated with Alzheimer’s disease.

2. Non-Pharmacological Approaches:

Structured Physical Exercise Program: The patient should be enrolled in a structured physical exercise program tailored to their abilities and preferences. Regular physical activity has shown positive effects in maintaining physical and cognitive health in individuals with Alzheimer’s disease.

Cognitive Stimulation Programs: Participation in cognitive stimulation programs is highly recommended. These programs involve engaging activities and exercises designed to stimulate cognitive functions and improve quality of life for individuals with Alzheimer’s disease. Activities may include puzzles, memory games, and social interactions that help maintain cognitive abilities.

Follow-Up:

A follow-up appointment is scheduled for four weeks from the initial Assessment. During this follow-up, we will closely monitor the patient’s symptoms and assess their response to the current medication regimen. Depending on the Assessment outcomes and the patient’s condition, there may be consideration for an adjustment in medication dosage to 16 mg orally daily.

The first step would be to administer standardized cognitive screening tests to evaluate his memory and cognitive functioning. Tests like the Mini-Mental State Examination (MMSE) (Gallegos et al., 2022) or Montreal Cognitive Assessment (MoCA) would help assess his current cognitive status.
I would also obtain a detailed medical history, including any family history of cognitive disorders, and conduct a thorough physical and neurological exam. This will provide important context about his overall health status.
To rule out other potential causes, laboratory tests should include a Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), and urinalysis to check for issues like a urinary tract infection (UTI) or diabetes that could be contributing to his symptoms (Cheng et al., 2021).
Continuous monitoring of his bathroom visits and behaviors would offer valuable insights. Specifically observing him there could distinguish whether the increased visits are due to genuine needs or repetitive behaviors linked to cognitive impairment (Sikdar et al., 2022).
Based on the information provided and diagnostic Assessment results, early Alzheimer’s disease seems a likely diagnosis. Treatment would then focus on managing symptoms and slowing progression. This may include galantamine medication (Mayo Clinic, 2022), a structured physical exercise program, and cognitive stimulation activities (Lau et al., 2021).

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