Denies nasal congestion, rhinorrhea or sore throat.

 

 

Case Scenario
A 76-year -old man is brought to the primary care office by his wife with concerns about his worsening memory. He is a retired lawyer who has recently been getting lost in the neighborhood where he has lived for 35 years. He was recently found wandering and has often been brought home by neighbors. When asked about this, he becomes angry and defensive and states that he was just trying to go to the store and get some bread.
His wife expressed concerns about his ability to make decisions as she came home two days ago to find that he allowed an unknown individual into the home to convince him to buy a home security system which they already have. He has also had trouble dressing himself and balancing his checkbook. At this point, she is considering hiring a day-time caregiver help him with dressing, meals and general supervision why she is at work.
Past Medical History: Gastroesophageal reflux (treated with diet); is negative for hypertension, hyperlipidemia, stroke or head injury or depression
Allergies: No known allergies
Medications: None
Family History
• Father deceased at age 78 of decline related to Alzheimer’s disease
• Mother deceased at age 80 of natural causes
• No siblings
Social History
• Denies smoking
• Denies alcohol or recreational drug use
• Retired lawyer
• Hobby: Golf at least twice a week
Review of Systems
• Constitutional: Denies fatigue or insomnia
• HEENT: Denies nasal congestion, rhinorrhea or sore throat.
• Chest: Denies dyspnea or coughing
• Heart: Denies chest pain, chest pressure or palpitations.
• Lymph: Denies lymph node swelling.
• Musculoskeletal: denies falls or loss of balance; denies joint point or swelling
General Physical Exam
• Constitutional: Alert, angry but cooperative
• Vital Signs: BP-128/72, T-98.6 F, P-76, RR-20
• Wt. 178 lbs., Ht. 6’0″, BMI 24.1
HEENT
• Head normocephalic; Pupils equal and reactive to light bilaterally; EOM’s intact
Neck/Lymph Nodes
• No abnormalities noted
Lungs
• Bilateral breath sounds clear throughout lung fields.
Heart
• S1 and S2 regular rate and rhythm, no rubs or murmurs.
Integumentary System
• Warm, dry and intact. Nail beds pink without clubbing.
Neurological
• Deep tendon reflexes (DTRs): 2/2; muscle tone and strength 5/5; no gait abnormalities; sensation intact bilaterally; no aphasia
Diagnostics
• Mini-Mental State Examination (MMSE): Baseline score 12 out of 30 (moderate dementia)
• MRI: hippocampal atrophy
• Based on the clinical presentation and diagnostic findings, the patient is diagnosed with Alzheimer’s type dementia.
Discussion Questions
1. Compare and contrast the pathophysiology between Alzheimer’s disease and frontotemporal dementia.
2. Identify the clinical findings from the case that supports a diagnosis of Alzheimer’s disease.
3. Explain one hypothesis that explains the development of Alzheimer’s disease
4. Discuss the patient’s likely stage of Alzheimer’s disease.

Sample Solution

ortunities immediately draw attention to the traits he processed and how they might have contributed to his leadership style. In the early 20th century, leadership traits were studied to determine what made certain people great leaders . The theory that derived from this research was known as the “Great Man Theory”.

Trait Approach

Scholarly studies have shown that there is a wide variety of different theoretical approaches to leadership. In a number of their research papers the trait approach continues to appear and therefore it would leave you to believe that there must be credibility in this theory. From the very beginning of any literature on de Gaulle, he and his leadership style are described through his characteristic. The strong referencing of de Gaulle’s characteristics leads to identifiable traits and draw evaluation of de Gaulle through this lens.

The trait theory was one of the first systematic attempts to study leadership . It focused on identifying the innate qualities and characteristics posed by great social, political, and military leaders . It was believed that people were born with these traits and only “great people possessed them .

In the mid 20th century the approach was challenged and suggested that no consistent set of traits differentiated leaders from non-leaders across a variety of situations . Recent years have seen the resurgence in the trait approach; in short, the trait approach is alive and well . It began with the emphasis on identifying the qualities of a great person; next, it shifted to include the impact of a situation on leadership; and most recently, it has shift back to re-emphasise the critical role of traits in effective leadership .

Historian Thomas Carlyle also had a major influence on this theory of leadership, at one point stating that, “The history of the world is but the biography of great men.” According to Carlyle, effective leaders are those gifted with divine inspiration and the right characteristics . Research has proven that the “Great man” theory is flawed in some aspects. One aspect being that great leaders are born with traits that make a good leader and they cannot be taught or developed over time with experience. Sociologist Herbert Spencer suggested that the leaders were products of the society in which they lived. In The Study of Sociology, Spencer wrote, “you must admit that the genesis of a great man depends on the long series of complex influences which has produced the race in which he appears, and the social state into which that race has slowly grown….Before he can remake his society, his society must make him.”

There is evidence to support for and against the great man theory. The suggestion that some people are natural leaders and therefore must have been born with some of the traits that make a good leader. However, individuals can learn and develop traits that will make them a good leader. Being self-aware and educati

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