(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: The patient, 84-year-old Grandma Zhang, was recently found by her family to be always losing things and her memory was getting worse and worse. She also said that her memory was getting worse and worse, and she had poor sleep quality at night, not only could she not sleep all the time, but also woke up easily after falling asleep, so she came to the hospital for consultation. Combining the patient’s specific situation and relevant examination results, the diagnosis of early stage dementia was confirmed. After a series of drug combination therapy, the patient’s symptoms were relieved.
Basic information】Female, 84 years old
Disease Type】Early stage of dementia
Hospital】Jixi City People’s Hospital
Date of consultation】March 2022
Treatment plan】Medication (Ginkgo biloba extract injection + Piracetam injection + Donepezil hydrochloride tablet + Meglumine hydrochloride tablet + Nifedipine controlled release tablet + Aspirin enteric solution tablet + Rosuvastatin calcium tablet + Zolpidem tartrate tablet)
Treatment Period】Treatment for 2 weeks, follow up after 6 months
【Treatment effect】The condition has improved, cognitive ability has improved
I. Initial consultation
The patient’s grandmother Zhang was brought to the clinic by her family, who said they found that the patient had been losing things for some time recently, and the patient could not remember what it was when asked by her family.
Detailed questioning of the patient’s medical history revealed that the main manifestation was memory loss, but for distant memory, the memory was relatively more clear. The elderly also had a change in their calculation ability, like paying for the checkout, which was sometimes difficult to calculate. In addition, the patient had some personality changes, from cheerful to silent and unsmiling, and also became sensitive and suspicious.
The patient had hypertension in the past, and although he took medication regularly, it was not well controlled, with blood pressure around 140-155/80-90 mmHg. Deny any other relevant medical history.
Some relevant examinations were given to the patient’s morbidity, and the cranial CT findings showed cavernous cerebral infarction in both basal ganglia areas and the right thalamus. Head and neck vascular ultrasound showed bilateral intimal thickening and multiple sclerotic plaque formation in the vertebral arteries and sclerotic plaque formation at the bifurcation of the head and arm trunks, EEG showed decreased wave amplitude, and the Simple Mental State Examination Scale score was 20. Combined with the patient’s medical history and relevant examinations, the patient could be diagnosed with the early stage of dementia.
II. Treatment history
Based on the patient’s morbidity and examination findings, it was decided to give the patient pharmacological treatment, to which the family and the patient agreed.
Firstly, Ginkgo biloba extract injection was given as a sedative to improve blood circulation in the brain; secondly, the patient was given neurotrophic medication for the brain, using piracetam injection as a sedative, and donepezil hydrochloride tablets were given orally to improve the neurotransmitter transmission function, thus improving the patient’s cognitive level; then, medication regulating the synaptic activity of neurons was used to improve the symptoms, using meperidine hydrochloride tablets orally; finally, the The patient was given hypertension and anti-atherosclerosis treatment for risk factors, using nifedipine controlled-release tablets orally to stabilize blood pressure, and aspirin enteric tablets orally and risuvastatin calcium tablets orally to anti-atherosclerosis; meanwhile, the patient was given sleep improvement medication, using zolpidem tartrate tablets to improve sleep.
III. Treatment effect
After applying Ginkgo biloba extract injection and piracetam injection for 2 weeks of sedation, the patient’s sleep quality was improved and memory improved, and discharge was granted. At the follow-up visit six months later, the patient’s mental status also improved, and he regained his usual optimistic and cheerful personality. The patient reported that he now felt better in spirit and memory, and his family added that the patient’s overall state was now significantly better than before.
IV. Notes
We are glad that the patient underwent active treatment and the adverse symptoms were controlled. Since lifestyle interventions are very important for disease control and slowing down the progression, patients should participate in more social activities and exercise appropriately; they can consume more foods rich in unsaturated fatty acids, such as deep-sea fish, etc. In addition, because dementia can easily lead to memory changes and getting lost, patients need to carry identification or contact information with them if they go out unaccompanied in order to prevent getting lost.
V. Personal insight
Dementia starts insidiously at an early stage and mainly manifests as a continuous progressive mental decline, and the most common symptom is memory impairment. However, for the elderly, memory impairment is mostly easy to be ignored in the early stage, as in this patient. Although there is no specific treatment to reverse or stop the progression of the disease, it is important to improve the quality of daily life of the patient if it can be detected at an early stage and given a comprehensive treatment strategy such as symptomatic support at an early stage. Therefore, when the above-mentioned conditions occur, early hospital consultation is advisable for prudent reasons.