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Advanced Neurology Alzheimer’s disease disclosure

to consult a neurologist. She did so, accompanied by her manage meals and shopping when her husband was
husband, and the specialist proposed to include the patient away. Regular cognitive follow-ups have not shown any
in a pharmacological trial that could benefit her in case her progression, with cognitive scores remaining stable so far.
symptoms should be consistent with the diagnosis of AD.
She was told that the inclusion criteria of the trial protocol 3. Case 2
required proof of the presence of amyloid in her brain, for E.D., a 73-year-old male patient, was referred to one of us by
which a brain PET scan was needed. The proposal was his neurologist for cognitive rehabilitation. He attended in
accepted and G.H. was included in the trial. the company of his wife. He has a university degree and is a
At the time of consultation, the patient led a normal business manager. He had consulted a physician four years
everyday life. As a housewife, she carried out household before because he confused his children’s names and showed
chores properly, was spatially orientated, went shopping, forgetfulness and unstable gait. On that occasion, his MMST
and could travel around the city on her own. Together with score was 28/30, and the remaining neurocognitive assessment
her husband, she traveled often out of town for leisure trips, showed impairment of episodic memory, and cortical-type
as they owned property 500 km away from Buenos Aires. denomination deficit. A diagnosis of MCI was made, and
follow-up and cognitive rehabilitation were prescribed.
The patient’s Mini-Mental State Test (MMST) score was
27/30; she showed a mild deficit in executive functions A second cognitive assessment was carried out
and had undergone some periods of low mood or drive. 12 months later, showing mild temporal disorientation,
The PET scan revealed brain amyloid, consistent with the MMST 26/30, very low memory and denomination scores,
diagnosis of AD. The doctor phoned and transmitted this and milder impairment in executive functions. The results
information to the patient’s husband, who was then driving were communicated by a neurologist to the patient and his
through a provincial route accompanied by his wife. On wife, telling them that such a cognitive profile was consistent
receiving it, he stopped the car at the roadside, told the with AD. His wife, a psychologist, openly rejected such
patient about the diagnosis, and that she was required a diagnosis, considering it “impossible,” and decided to
to return to Buenos Aires as soon as possible to start her seek a second opinion. A new specialist prescribed brain
participation in the trial. magnetic resonance imaging (MRI). Hydrocephalus was
then diagnosed, and the patient underwent valve shunting,
Back in town, the couple informed their sons about which was probably ventriculoperitoneal.
the AD diagnosis. Immediately, a radical change in the
couple’s everyday life ensued. The husband was profoundly The patient consulted his physician again three years
dismayed and controlled all his wife’s movements, stopped later. His wife said that he had quit using his cellphone
her from performing regular shopping, and would not let except for answering incoming calls, and no longer managed
her stay at home or go out on her own. She consequently his finances. He also experienced exacerbation in memory
developed a very low mood, became depressed, got out of deficits, and could not follow television films or programs.
bed late, did not make up the bed anymore, and only got He had quit driving, after having experienced two car
dressed late in the morning. She had almost no more social crashes. He consequently did not travel alone nor went out
interactions with others. for shopping anymore. A third cognitive assessment showed
progression, with aggravated executive and visuoconstructive
Together, they consulted one of us. The therapeutic impairment. Cognitive rehabilitation was prescribed.
intervention aimed to clarify the situation to the patient and
her husband, suggesting MCI as an alternative diagnosis, His wife ascribed his impairment to the hydrocephalus
given her previous cognitively independent performance and reported unsolved shunt valve malfunctioning. She
in everyday life, not necessarily implying rapid progression stated that he was otherwise doing “alright,” that they were
to AD. They were told that the time elapsed between MCI planning a trip abroad, and that “luckily he doesn’t have AD.”
and its eventual progression is not easily predictable, but She did not look distressed and planned to consult further
should be closely monitored and properly addressed as about the shunting, apart from tackling rehabilitation.
it may induce undesirable emotional consequences that E.D.’s conversation was coherent and lively, albeit with
may worsen the prognosis and should be avoided. 2,17,21 anosognosia of his predicament. He felt well, went out with
We provided cognitive, physical, and social interaction friends, and traveled, but admitted eventual forgetfulness.
guidelines as prevention and containment strategies.
4. Case 3
After 10 months, G.H. consulted us on her own, twice
a week. She had started to exercise with a personal trainer, M.G., a 63-year-old, high-school-educated female
stayed at home under the care of her daughter, and could patient, was treated by her psychiatrist upon a diagnosis

Volume 4 Issue 2 (2025) 82 doi: 10.36922/an.4393