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After completing this case study, the reader should be able to:

  • Assess cognitive deficits and noncognitive/behavioral symptoms of Alzheimer disease (AD).

  • Evaluate the drug therapy regimens for medications that could interfere with the AD process and future drug therapy recommendations.

  • Design a nonpharmacologic plan for a patient with AD based on target symptoms.

  • Recommend appropriate pharmacotherapy to manage the cognitive and behavioral symptoms of AD.

  • Determine appropriate education and counseling to provide to patients and care partners about AD, the possible benefits and adverse effects of pharmacotherapy for the disorder, and the importance of adherence to therapy.


Chief Complaint

“I’m not sure why we are here. Ann said I have to move and I don’t want to because there are people stealing from my house and I have to catch them before they take it all. My kids are just worriers.”


Jane Dale is a 74-year-old Caucasian woman who presents to the geriatric care clinic for a routine visit accompanied by her daughter Ann. Jane was diagnosed with AD 3 years ago. Her initial symptoms included forgetting times and dates easily, misplacing and losing items, repeating questions and current events, the inability to answer questions, and increasing difficulty with managing finances. She was initially treated with oral rivastigmine that was eventually discontinued due to intolerable side effects although it worked well to slow her decline. Treatment with donepezil 10 mg at bedtime has been well tolerated for the past 2 years, and Jane has been participating more actively in family and social functions. Behavioral problems have been infrequent since diagnosis and have not required treatment. Since her last clinic visit, Jane began using an over-the-counter patch for her urinary incontinence.

Jane lives on her own; her daughter and son share the duties of visiting her twice a day. They have been able to maintain a regular routine with her mother’s daily activities, nutrition, and financial responsibilities, using lists and notes to help Jane orient herself. Ann sets up a medication box weekly for Jane but has recently noticed quite a few pills left in the container at the end of the week. When Ann asks her mother about them, Jane has thrown the medication bottles at her and tells her “You take them!” Ann is moving in 1 month to live closer to her own daughter to help with grandchildren and has asked her younger unmarried brother, Sam, to help take care of their mother. Sam has agreed to be his mother’s caregiver. He lives and works across town and is not sure if he wants to move his mother into his home. There has been discussion about ...

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