Alzheimer Disease
The pathophysiology and diagnosis of this disease are still being investigated and as a result both are vague. Theories concerning pathophysiology include loss of certain neurotransmitter stimulation, mutation or alterations of certain proteins, and activation of certain processes that cause excess calcium. Irrespective of etiology, Alzheimer Disease is characterized by severe cognitive dysfunction. Signs and symptoms may include forgetfulness, emotional upset, decreased abstraction, disorientation, dyspraxia, irritability, agitation, restlessness, depression, hostility, rigidity, flexion posturing, propulsion, and retropropulsion. This could be a diagnosis for Mr R.D. due to his withdrawal from social activity, fatigue, and rigidity when walking. This disease may be ruled out by conducting scans, blood work and examination of his clinical history.
Huntington Disease
Huntington disease is a hereditary-degenerative disorder caused by an autosomal dominant mutation located on chromosome 4. Onset generally occurs between 25 and 45 years of age. This would help rule out Huntington Disease for Mr. R.D, except for the fact that age of onset can differ based on the length of the abnormal tract present in the disease. Clinical manifestations are caused by decreased amounts of GABA and an increase in dopaminergic activity causing symptoms including hypotonia, hyperkinesia, chorea, dementia, short term memory loss, bradyphrenia, apathy, restlessness, disinhibition, irritability, affectivity, euphoria and depression. Mr R.D exhibits some of these symptoms, including withdrawal from activity (which may indicate depression) and abnormal movements such as tremor, stiffness and abnormal gait. Family history and genetic testing may be used to help rule out this disorder.
Communicating hydrocephalus
This disease is characterized by obstruction of the ventricles in the brain causing disruption of CSF flow. Common causes include head trauma (such as a fall) or potentially meningitis. Signs and symptoms can occur over hours or slowly over time depending on the cause. Common manifestations include declining memory, unsteady broad-based gait, apathy, inattentiveness, indifference and urinary incontinence. Mr R.D. exhibits some of these symptoms, such as the depression, abnormal gait, and urinary problems. To rule out this disorder, results of the physical exam will be taken into consideration. CT scan and MRI may also help rule out this condition for Mr. R.D.