Christian counseling: principles and practice

Mr. H

Korea

Mr. H case study

What is the client's most prominent presenting issues (that is, what seems to take priority as being wrong)?

Mr. H has shown a sharp decline in cognitive functioning. He has quit his job without warning and without consulting with his spouse (who is economically as well as emotionally affected by this decision), has shown difficulty remembering basic tasks and words that a man of his education and background should be able to retrieve easily, and is exhibiting signs of disorientation. Despite being an accomplished outdoorsman he has gotten lost while hiking; has difficulty reading; and although he was a science teacher has difficulty doing basic math. He also has trouble performing basic acts of self-care and memory exercises.

Q2. What else do you feel you need to know (or, what might be some areas you may ask about in order to determine what is going on and how severe the problem may be)?

Alzheimer's disease can have a genetic component, so inquiring into the history of Mr. H's family might be useful, particularly if the dementia of the family members was early-onset in nature (early -- onset Alzheimer's disease is defined as occurring before the age of 65 and tends to have a stronger heritable component than other forms of Alzheimer's). Also, other disorders need to be eliminated as the source of his dementia -- both psychological and physical -- as well as the possibilities that his cognitive problems might be caused by any medications he is taking. Further tests would be needed to perform a conclusive diagnosis, and the patient would need to be interviewed to a greater extent, given that most of the available information has been given by the patient's spouse.

Q3. What do you think may be your initial diagnosis based on the information given in the case study? Why?

The criteria for diagnosing Alzheimer's disease according to the DSM include the following factors: memory impairment; language disturbance; difficulty in carrying out motor activities "despite intact motor function" the "failure to recognize or identify objects despite intact sensory function" and "disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting" (Diagnostic criteria for dementia of the Alzheimer's type, 2013, BehaveNet). Mr. H exhibits signs of all of these problems with the possible exception of physical apraxia. However, according to the DSM other possible causes should be eliminated such as "cerebrovascular disease, Parkinson's disease, Huntington's disease;" or brain traumas or tumors; medications; or other conditions known to cause dementia (Diagnostic criteria for dementia of the Alzheimer's type, 2013, BehaveNet).

Q4. What, if any, psychospiritual factors might be present and maintaining the presenting issue?

Although Mr. H appears unaware of the seriousness of his condition, his wife likely is undergoing tremendous suffering, given that it is not expected that someone as young as Mr. H (he is 61) would show signs of dementia. The precise causation of Alzheimer's is not known, although early-onset has a particularly strong genetic component. Mrs. H may be feeling guilt (including survivor's guilt that she is healthy); worries about being a caregiver; worries about taking on additional financial responsibilities and also feeling a sense of hurt and shame. Like many people, she may be asking 'why me' and may even be going through the stages of grief one experiences at the death of a loved one (such as denial and rage) even though Mr. H is still physically present.

Q5. What are possible methods of treatment or referral?

At present, there are no known cures for Alzheimer's, although the disease is sometimes treated with support groups and specific types of drug therapy to slow the progression of this chronic condition. At present, two types of drugs are commonly prescribed to Alzheimer's patients. The first type, cholinesterase inhibitors "work by boosting levels of a cell-to-cell communication chemical depleted in the brain by Alzheimer's disease" but at best they only mitigate symptoms -- once again, there is no 'cure (Alzheimer's disease: Treatment and drugs, 2013, Mayo Clinic). "The main side effects of these drugs include diarrhea, nausea and sleep disturbances" (Alzheimer's disease: Treatment and drugs, 2013, Mayo Clinic). Memantine "works in another brain cell communication network and slows the progression of symptoms with moderate to severe Alzheimer's disease" (Alzheimer's disease: Treatment and drugs, 2013, Mayo Clinic). However, in the case of both drugs, this is merely slows the progression of the drugs, and the drugs do not work well with all patients -- approximately half of all patients can expect some improvement in their symptoms with such therapy (Alzheimer's disease: Treatment and drugs, 2013, Mayo Clinic).