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How I Treat: Keeping Caregiver Concerns in Mind Case Presentation
The Case:
The patient is a 71-year-old male who has been living with his wife at home for the past 42 years. The patient is a retired CPA that has past medical history of hypertension, hyperlipidemia, mood disorder, and dementia. The patient presents to the office with his wife who expresses increased concerns with recent behavioral changes over the past 2 weeks. The patient has no other complaints and has maintained appetite and hydration. Vital signs are unremarkable during examination today. Here are his current medications:
- Lisinopril 10 mg daily
- Atorvastatin 40 mg daily
- Donepezil 5 mg nightly
- Memantine 10 mg twice daily
- Escitalopram 10 mg daily
- Quetiapine 25 mg nightly
The patient’s wife reports that the patient has been having “moments of rage” with raising his fists at his wife during conversations throughout the day. His wife has attempted to journal potential triggers and feels “at a loss because I am unable to figure out why his is so triggered”. The patient has also been yelling at his grandchildren, who have been visiting for the summer break, and now “everyone in the house is walking on eggshells”. His wife felt it was necessary to be seen after the patient struck his wife as she was preparing dinner for the family, which she reports was unprovoked. The patient’s diet and hydration have not changed over the past month.
The patient admits to having increased agitation but reports that his grandchildren “are just being too loud” but is unable to recall his most recent altercation with striking his wife.
