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[DATE]

[COMPANY NAME]
[Company address]

CASE STUDY 6 STILL


ALICE
JULIA YEWCIC
DR. MCCOY
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INTAKE OUTLINE AND REPORT

YOUR NAME: Julia Yewcic

CLIENTS NAME: Alice Howland

CLIENTS APPROXIMATE AGE: 50

IDENTIFYING INFORMATION AND REFERRAL STATEMENT

Alice Howland is a 50-year-old woman currently living in New York with her daughter.
Alice Howland is married to her husband John Howland they have three children that
are in college and older. She also has two grandchildren, twins a girl and a boy. Alice is
a former professor of Linguistics at Columbia University. She wrote a seminal textbook
called, Neurons to Nouns while raising her three children, she was known as a very
intellectual woman.

Alice had been previously seeing Neurologist for the rare disorder, early onset familial
Alzheimer disease. The clients daughter reports that her mother has been declining
rapidly. Alice has been referred by her daughter, Lydia. Lydia is looking for techniques
of coping and managing her mothers disorder for herself and her family.

PRESENTING COMPLAINT:

The clients daughter, Lydia reports her mothers brain is deteriorating rapidly, now
they are passed the point of treatment and her mother is becoming incoherent. Lydia
reports that her mother is barely speaking and struggles to form words. The client has
previously visited her neurologist for treatment to reduce her symptoms of early
Alzheimer disease. Now, Lydia is seeking help for way of coping and managing her
mother during the end of her condition trying to figure out how to spend her final
days. (read over and edit) Hopes to find a way to cope and manage.

HISTORY OF PRESENTING COMPLAINT:

Lydia reports her mothers first concern that something was wrong was when she
could not remember certain words during her lecture. Lydia reports soon after this
incident her mother felt disoriented during her run on campus that she is very
familiar with. Lydia reports that her mother, Alice then made an appointment to see
her neurologist. Lydia shares that during her mothers visit with the neurologist she
was tested on her memory. Lydia shares he doctor gave her mother a name and
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address to remember, she was asked to repeat and was told that he was going to ask
her for it later on during he visits. After answering personal questions and a few
memory tests, Alice failed to remember the address that she was given.
Lydia reports that The neurologist told Alice that he wanted to do an MRI and told
Alice to bring someone close to her for her next visit.
Lydia reports that during her mothers next visit she went by herself. Lydia shares that
her mothers MRI results came back with no sign of anything abnormal, and her blood
test results came back fine. Lydia shares that the neurologist says that he has
sporadic memory impairment out of proportion her age and that there is evidence of
decline level of mental function. Lydia says that the neurologist then suggests t to
Alice that they do a PET scan.
Lydia states that the neurologist tells her mother that she fits the criteria for early
onset Alzheimers disease.

Lydia reports that gradually her mother struggled with her lectures to her students,
struggling to find the right words she is trying to say.
The clients daughter reports a few of her mothers major stressors. Lydia shares that
her mother reported to her that Lydias father, the clients husband John, was at first
in denial of Alices condition. Lydia reports that her mother woke up in the middle of
the night and had a mental breakdown as she told her husband everything that she
was seeing a neurologist who thinks she has early onset Alzheimers disease.
Lydia shares that her mother may lose her job and that her students are very
disappointed with her class and lectures. Lydia shares that her mothers boss tells her
that students called her lectures erratic and hard to follow. Lydia reports that her
mothers job means a lot to her and fears losing it. She shares that her mother then
told her boss that she was diagnosed with early onset Alzheimer disease.

Another major stressor that Lydia shares her mother is facing is the fact that early
onset Alzheimer disease is genetic and that she can pass it down to one of her
children. Lydia reports her mother and father are devastated that of her three children
it could be passed to any of them. She shares that if they do have that gene they will
100% have the disease.
Lydia reports that her mother reports having good and bad days and it is
unpredictable.

Lydia reports another stressor that her mother is having and that is she will be having
grandchildren soon; her oldest daughter Anna is having twins.
Lastly Lydia reports her mother saying that she does not want to be a burden on their
family and fears leaving them behind.
She also reports that another stressor Alice reported was losing her independence due
to this disease.

Lydia reports that her mother said she was seeing a neurologist when her mother
started to recognize her symptoms after feeling confused and disoriented on her run
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on campus and struggling to remember a word during her lecture. The clients
daughter reports that her mothers neurologist came to the conclusion after multiple
tests (MRI, PET scan and memory tests) that Alice has early onset Alzheimer disease.
Lydia reports that her mother s condition is worsening rapidly.

MEDICAL:

Lydia reports that her mother always appeared healthy, she says that her mother was
still active and went for runs before her diagnosis.
Alice reports to her neurologist that she takes multivitamins, iron, calcium, flaxseed
oil. To reduce her symptoms Alice reports being prescribed Namenda, and Aricept
during her early stages of her diagnosis. Lydia reports her mother creating a video on
her laptop during her early stages of the disease. The video, Lydia reports was Alice
instructing herself to kill herself once she cannot answer some simple questions that
she answers every morning when she wakes up such as; what is the name of your
oldest daughter, and what street do you live on.
Lydia reports no substance abuse in the clients life.

PERSONAL HISTORY:

Lydia reports that her mother was one of two children. Information on Alices birth
and infancy has not been reported thus far.
Lydia shares that when her mother was 18 years old she lost her mother and sister in
a car crash and in 1999. Lydia shares that her mother was close with her sister
growing up. The clients father died to liver failure, he was an alcoholic. Lydia reports
that her mother was not very close with her father.
She shares that her mother also lost her sister when she was 18 years old in the car
crash with her mother. Lydia says that her mother, Alice and her sister were close
growing up.

Lydia reports that her mother was a very intellectual woman, she wrote her own
seminal textbook, Neurons for Nouns while raising her three children. Lydia shares
that her mother was a well known professor who was passionate for teaching
Linguistics.

Lydia shares that the client has always been healthy and enjoys going for runs around
campus.

Lydia shares that when her mother felt disoriented on a run, and could not find the
right word during her lecture she then decided to see her neurologist. Lydia reports
her mother going through multiple tests consisting of MRI, PET scan and memory
tests. The neurologist came to a conclusion that Lydias mother, Alice Howland has
onset early familial Alzheimers disease.
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Lydia shares that when her mother told her father about her concerns, her father was
in denial and did not want to believe what Alice was saying.
She also reports that her father, John went with Alice to her next appointment with
the neurologist. Alices daughter shares that during that visit they found out the
Alices condition is genetic and that its is definite that at least one of her children will
be carrying the same gene and that if they would like to know they could be tested for
it.
Lydia shares that this devastated her mother and father when they find out after
testing that their oldest daughter, Anna has the gene.

Lydia reports that her father is a physician whos job is taking him out of the state
with the Mayo Clinic. She shares that her mother states that this is a huge
opportunity that he cannot put on hold because the opportunity will be lost. Lydia
reports that her father takes the opportunity and leaves Alice in their home with a
care taker named Elena, and in the care of their youngest daughter Lydia who comes
back from LA. Lydia shares that her mother understood that John had to leave
because it would not be good for them financially and because he loves his job.

FAMILY CONSTELLATION:

Alices husband, John Howland: They are happily married and have three children
together. He is a successful physician who was offered a job with the Mayo Clinic in
Minnesota which requires him to move out of state while Alice is sick. Lydia
reports that her mother told her that at first John was in denial of Alices disease.
The clients daughter reports that her mother told her that John leaves her at home
in the care of Lydia and a care taker named Elena.

Anna, Alices oldest daughter: Lydia reports that her mother shares that she loves
her daughter very much and is very proud of her. She shares that the client reports
her daughter testing positive for the gene and in her lifetime she will develop early
onset familial Alzheimer disease. Lydia reports that her mother shares that Anna
was pregnant with twins around the time of Alices diagnosis and she was able to
hold and see her grandchildren. Anna is a successful lawyer and is very intelligent.

Lydia youngest daughter: Lydia is away across the country in LA auditioning for
different roles in hopes of pursuing a career in acting. Lydia reports that she and
her mother argued often over her career path choice of being in theatre. Lydia
reports that she felt like her mother did not fully support her dreams of acting. She
shares that she became closer with her mother when she was diagnosed. Lydia
reports moving back from LA to help take care of her mother when her father
leaves to take his job opportunity. Lydia spends her time with her mother during
her last days.
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Alices mother: Lydia states that Alice said that her mother passed away in a car
crash when she was 18 years old. Client does not report much about her
relationship with her mother to her daughter Lydia.

Alices father: Lydia shares that Alices father died in 1999 of liver failure,
cirrhosis. He was an alcoholic. He was really sick, towards the end of his life and
became incoherent. Lydia reports that her mother said that she was not close with
her father. He lived in New Hampshire they did not see each other often.

Alices sister: Alice reports to Lydia that her sister died in a car crash when she was
18 years old. This was Alices only sibling. Lydia reports that her mother and her
mothers sister were very close when they were younger.

CLINICAL DESCRIPTIONS, IMPRESSIONS, AND OBSERVATIONS:

Lydia reports that her mother is no longer teaching at Columbia University. Lydia
reports at this stage in her mothers disease she is no longer speaking clearly or
capable of completing full sentences. She shares that the client makes grunting
noises to communicate but only uses one word.
The clients daughter reports needing a treatment plan that will help her family
cope and understand what has and what is happening to their mother and wife.

Lydia presents her mothers symptoms that her mother has reported to her.
Lydia shares that her mother stated it started when she could not remember the
right word during one of her lectures and getting disoriented on her run around
campus that she is very familiar with. Lydia reports that her mother shares that
during her visit with her neurologist she failed to remember a name and address
she was given to remember and the neurologist said that she fits the criteria for
early onset Alzheimers disease. Lydia reports that the client shares that her MRI
and blood tests came back fine but the neurologist said There is evidence of
decline level of mental function and that sporadic memory impairment is out of
proportion to her age.

In addition, Lydia reports that the client reports that she could not remember her
sons girlfriends name at Christmas dinner after they had already been introduced
within the hour. She shares that the client wet herself after feeling disoriented and
could not remember where the bathroom was in her home.

Lydia shares that her mother reported that she could not remember times and dates of
events, for example, Alice asked her husband John when Anna was coming and what
time twice within the hour, and She also asked Lydia what time her performance was
multiple times.
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Lydia reports the client shares that she no longer goes for runs anymore or teaches.
Lydia shares that her mother can no longer enjoy the things she use to enjoy.
She shares that the client cannot be left alone and needs a care giver present at all
times to watch her. Lydia shares that her mother and fathers relationship changed
because her father had to leave for his job and it was for the best for his job and their
financial state. However, Lydia reports that her mother shares that now that Lydia is
living back at home that they have became closer as Lydia stays with her mother
during this hard time.

She shares that her mother is now in her final stage of her disease and that she is
almost completely incoherent. Lydia reports that her mother gives small responses and
cannot form words or sentences. The clients impairment is very severe.

Lydia shares that in the past her mother made a video to herself instructing herself to
take all the pills she has in her draw in her bedroom once she could no longer answer
the simple questions she has saved in her phone. This is a suicidal message to herself.

TENTATIVE DIAGNOSIS:

Early-onset familial. Alzheimer's is an uncommon form of dementia that strikes people


younger than age 65. Of all the people who have Alzheimer's disease, about 5 percent
develop symptoms before age 65.

Causes: Unknown; But others with early-onset Alzheimer's have a type of the disease
called "familial Alzheimer's disease." They're likely to have a parent or grandparent who
also developed Alzheimer's at a younger age.
Genetic testing for these mutations is available,

Familial Alzheimers disease (FAD) is a rare form of Alzheimers that is


entirely passed down through family, being inherited from a
parent. FAD accounts for between 2-3% of all cases of Alzheimers and
usually has a much earlier onset than other types of Alzheimers, with
symptoms developing in their 30s or 40s.

Researchers believe that people with FAD have a mutation in one to


three genes known to aid in the development of
Alzheimers: PS1, PS2 and AAP. All of these genes influence the
production of beta-amyloid proteins that can clump together and
become a hallmark characteristic of Alzheimers. People diagnosed
with Familial Alzheimers have generally had one parent diagnosed
with the disease and siblings and children each have a 50% chance of
inheriting it.
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http://www.alzheimers.net/2-19-15-familial-alzheimers-disease/
Symptoms of early-onset Alzheimers can include:

Memory problems which interfere with everyday life. This may include
forgetting messages or recent events which would normally be
remembered, or repeating questions.

Confusion or disorientation. People may become confused in unfamiliar


situations and lose a sense of place and time.

Changes in personality and behaviour. These may be subtle at first and


could include apathy, depression or loss of confidence.

Language problems difficulty finding the right words

http://www.alzheimersresearchuk.org/about-dementia/types-of-dementia/alzheimers-
disease/early-onset-alzheimers/

DSM-5 Alzheimers and Dementia


The DSM-5 replaces the term dementia with major neurocognitive disorder and mild
neurocognitive disorder. The new terms focus on a decline, rather than a deficit, in
function. The new criteria focus less on memory impairment, allowing for variables
associated with conditions that sometimes begin with declines in speech or language
usage ability.

According to the DSM-5s criteria, individuals with major neurocognitive disorder exhibit
cognitive deficits that interfere with independence. Persons with mild neurocognitive
disorder may retain the ability to be independent.
https://www.crisisprevention.com/Blog/June-2013/DSM-5-New-Diagnostic-Criteria

INITIAL TREATMENT RECOMMENDATIONS:

The client is now in her final stages of her disease. The outcome is not good, the client,
Alice is going to die. Alice only has a few more weeks left to live. The client should stay
in her home as comfortable as possible with her loved ones with her.

As for the family, family therapy sessions should be made for the family to cope
together and learn different techniques of coping. To gain a better understanding what
is happening

Lydia should also attend therapy to deal with the trauma of spending her mothers last
few days with her.
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INITIAL PROGNOSIS:

Family therapy to talk it through, so they understand whats going to happen


Prognosis, outcome not good does not have long, weeks.
The Howland family should attend family therapy sessions together to get a better understanding
for what is happening and so that they have the opportunity to share their feelings with each
other in an appropriate setting. This will also bring Alices family closer.
The client, Alice Howland will live for a few more weeks. Make sure Alice is comfortable in her
home during her last few weeks of living surrounded by her loved ones.
Family should attend family therapy sessions together to cope with the tragic loss of their mother
and wife once she is gone.

Works Cited:

https://www.crisisprevention.com/Blog/June-2013/DSM-5-New-Diagnostic-Criteria
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http://www.alzheimersresearchuk.org/about-dementia/types-of-dementia/alzheimers-
disease/early-onset-alzheimers/

http://www.alzheimers.net/2-19-15-familial-alzheimers-disease/

https://www.crisisprevention.com/Blog/June-2013/DSM-5-New-Diagnostic-Criteria

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