Module 23: Concept of Cognition
Case Study: Parts 1 and 2
Case Study, Part 1 (pp. 1715–1716)
Victor Wallace is a 74-year-old Caucasian male who was diagnosed with moderate
Alzheimer disease 2 years ago. Mr. Wallace lives with his 50-year-old daughter, Anne
Marie, who is his primary caretaker. His wife of 52 years died of pancreatic cancer 18
months ago.
Mr. Wallace presents at his gerontologist’s office at 9:30 on Thursday morning. Ms.
Wallace requested the appointment because she is concerned about the changes she
has seen in her father over the past month. As the nurse working with Mr. Wallace’s
gerontologist, you conduct an initial assessment and interview with Mr. Wallace and Ms.
Wallace. Ms. Wallace reports that Mr. Wallace has exhibited increased confusion and
anxiety at home and at the adult day care center he attends each day while she is at
work.
In the past, Mr. Wallace only had these problems in unfamiliar settings. He is also
experiencing a decline in language, increasingly using the wrong words to describe
common objects and relying on scanning speech to find words. However, Ms. Wallace’s
main concern is her father’s refusal to carry out the basic activities of daily living (ADLs)
he is still capable of performing. When you ask Mr. Wallace about the ADLs, he says,
“There’s no point in trying because I won’t be able to do them much longer.” As you
observe Mr. Wallace, you note that he seems agitated. He is sitting on the edge of his
chair, tapping his foot and rapping his hands on his knees. When you ask him basic
questions, he has a hard time coming up with answers. When he can’t find the words he
wants, he just repeats the phrase “That’s how it is.”
Mr. Wallace’s vital signs and weight are normal, and his physical condition is good for a
man his age. You administer the Cornell Scale for Depression in Dementia and his
score is 17, indicating high probability of depression. The gerontologist maintains Mr.
Wallace’s current dose of 28 mg of memantine (Namenda) per day to slow the
progression of his Alzheimer symptoms. She then adds sertraline (Zoloft), an SSRI, to
treat his depression symptoms. Mr. Wallace is to start out taking 50 mg of sertraline per
day, gradually working up to 150 mg per day over a 6-week period.
, Question 1
How do your observations of Mr. Wallace correlate with the changes Ms. Wallace
reports?
Despite his vital signs and weight being within the normal ranges, it was clear that the
actions portrayed such as being agitated and not being able to come up with answers to
basic questions, using repetitive phrases, and having no motivation to complete activity
because he can’t do them much longer.
Question 2
What aspects of Mr. Wallace’s presentation prompts you to test him for depression?
Stating, “There’s no point in trying because I won’t be able to do them much longer”,
being agitated, and actions such as sitting on the edge of the chair.
Question 3
Why might Mr. Wallace’s increased confusion in familiar settings be a concern for Ms.
Wallace?
If he’s in a setting in which he is typically familiar, he should already be familiar with his
surroundings and the individuals around him. Since it is the opposite and he’s showing
signs of confusion in familiar settings, it raises a concern.
Question 4
Why is it important to distinguish between Mr. Wallace’s refusal to perform ADLs and an
inability to do so?
To confirm that it is something he is used to doing or able to do before labeling it as him
being physically unable to do so.
Question 5
Would speech therapy be an appropriate intervention for Mr. Wallace? Why or why not?
Yes, being that he is having trouble saying words and referring back to the same phrase,
having him participate in speech therapy where he can sound out his words and practice
completing sentences will be helpful.
Question 6
Refer to the exemplar on Alzheimer disease in this module: How would a change in Mr.
Case Study: Parts 1 and 2
Case Study, Part 1 (pp. 1715–1716)
Victor Wallace is a 74-year-old Caucasian male who was diagnosed with moderate
Alzheimer disease 2 years ago. Mr. Wallace lives with his 50-year-old daughter, Anne
Marie, who is his primary caretaker. His wife of 52 years died of pancreatic cancer 18
months ago.
Mr. Wallace presents at his gerontologist’s office at 9:30 on Thursday morning. Ms.
Wallace requested the appointment because she is concerned about the changes she
has seen in her father over the past month. As the nurse working with Mr. Wallace’s
gerontologist, you conduct an initial assessment and interview with Mr. Wallace and Ms.
Wallace. Ms. Wallace reports that Mr. Wallace has exhibited increased confusion and
anxiety at home and at the adult day care center he attends each day while she is at
work.
In the past, Mr. Wallace only had these problems in unfamiliar settings. He is also
experiencing a decline in language, increasingly using the wrong words to describe
common objects and relying on scanning speech to find words. However, Ms. Wallace’s
main concern is her father’s refusal to carry out the basic activities of daily living (ADLs)
he is still capable of performing. When you ask Mr. Wallace about the ADLs, he says,
“There’s no point in trying because I won’t be able to do them much longer.” As you
observe Mr. Wallace, you note that he seems agitated. He is sitting on the edge of his
chair, tapping his foot and rapping his hands on his knees. When you ask him basic
questions, he has a hard time coming up with answers. When he can’t find the words he
wants, he just repeats the phrase “That’s how it is.”
Mr. Wallace’s vital signs and weight are normal, and his physical condition is good for a
man his age. You administer the Cornell Scale for Depression in Dementia and his
score is 17, indicating high probability of depression. The gerontologist maintains Mr.
Wallace’s current dose of 28 mg of memantine (Namenda) per day to slow the
progression of his Alzheimer symptoms. She then adds sertraline (Zoloft), an SSRI, to
treat his depression symptoms. Mr. Wallace is to start out taking 50 mg of sertraline per
day, gradually working up to 150 mg per day over a 6-week period.
, Question 1
How do your observations of Mr. Wallace correlate with the changes Ms. Wallace
reports?
Despite his vital signs and weight being within the normal ranges, it was clear that the
actions portrayed such as being agitated and not being able to come up with answers to
basic questions, using repetitive phrases, and having no motivation to complete activity
because he can’t do them much longer.
Question 2
What aspects of Mr. Wallace’s presentation prompts you to test him for depression?
Stating, “There’s no point in trying because I won’t be able to do them much longer”,
being agitated, and actions such as sitting on the edge of the chair.
Question 3
Why might Mr. Wallace’s increased confusion in familiar settings be a concern for Ms.
Wallace?
If he’s in a setting in which he is typically familiar, he should already be familiar with his
surroundings and the individuals around him. Since it is the opposite and he’s showing
signs of confusion in familiar settings, it raises a concern.
Question 4
Why is it important to distinguish between Mr. Wallace’s refusal to perform ADLs and an
inability to do so?
To confirm that it is something he is used to doing or able to do before labeling it as him
being physically unable to do so.
Question 5
Would speech therapy be an appropriate intervention for Mr. Wallace? Why or why not?
Yes, being that he is having trouble saying words and referring back to the same phrase,
having him participate in speech therapy where he can sound out his words and practice
completing sentences will be helpful.
Question 6
Refer to the exemplar on Alzheimer disease in this module: How would a change in Mr.
