Soetiono Soetiman - Alzheimer's disease (Indonesia) Posted on September 13, 2012
Name: Soetiono Soetiman 
Sex: Male
Country: Indonesia
Age: 62
Diagnoses: 1.Alzheimer's disease 2. ischemic cerebrovascular disease, Mutiple Lacunar Infarction, subcortical arteriosclerotic 3. Coronary atherosclerotic heart disease 4. Hypertension level 3, very high risk, hypertensive renal disease 5. type 2 diabetes 6. Hyperhomocysteinemia 7. Acute enteritis
Admission Date: July 7, 2012
Days Admitted to Hospital: 32
The patients would fall into irritability and couldn't control himself. The disease progress gradually and was accompanied by mild memory slow down. The social skills slowed down. The patient retired 3 years ago. The disease aggravated gradually. So he went to a local hospital for MRI examination of his head. He was diagnosed clearly with Alzheimer's disease. He didn't receive special treatment. The patient had slow response and easy fatigability. Occasionally, he had dizziness and hypogeusia.
Admission PE:
Bp: 162/105mmHg; Hr: 85/min, temperature: 36.2 deg. The respiratory sounds in both lungs were found to be clear with no signs of dry or moist rales. The heart rhythms were regular. There was a 3rd degree murmur of puffing character in the mitral valve systole. The abdomen was distended and soft, with no pressing pain or rebound tenderness. The liver and spleen were not palpable. There was no swelling in the lower limbs. There was obvious skin pigmentation below both ankle joints, with no ulcerations.
Nervous System Examination:
Soetiono Soetiman was alert and his mental faculties were good. There was a lack of facial expressions. His responses were slightly slow. The memory was in decline. The calculation abilities, insight ability and orientation were normal. Both pupils were equal in size and their diameter was 3.5mms. Both eyeballs could move flexibly and the pupils reacted normally to light stimulus. The forehead wrinkle pattern was symmetrical. The closing ability of the eyelids was strong. The bilateral nasolabial sulcus was equal in depth. The tongue was in the center of the oral cavity. The raising ability of the soft palate was strong. The muscle strength of all four limbs was level 5. The muscle tone of all four limbs was almost normal. The tendon reflexes of both upper limbs were normal. The bilateral patellar tendon reflex was not elicited. The left Achilles tendon reflex was normal. The right Achilles tendon reflex was decreased. The abdominal reflex was not elicited. The sucking reflex was positive. The left side Hoffmann's sign and Rossolimo's sign were positive. The right side Hoffmann's sign and Rossolimo's sign were negative. The bilateral palm jaw reflex was negative. The bilateral Babinski's sign was negative. The bilateral rapid rotation test was clumsy. The examination results of the coordinated movements of all four limbs were normal. The algesia and seismesthesia below the bilateral ankle joints was decreased. There were no signs of meningeal irritation. Head MRI(2009-2-15): brain atrophy, multiple ischemia focus.
Treatment:
We initially gave Soetiono Soetiman a complete examination. He was given treatment to improve the blood circulation in order to increase the blood supply to the brain, to improve the renal function and nourishment for the neurons. The renal functioning was improved. He also received treatment to control the psychiatric symptoms and had the blood pressure and blood sugar level brought under control. The patient suffered from diarrhea and fever 5 days before discharge. The highest temperature was 39.5 degree. He had unclean eating before diarrhea. After he received symptomatic treatment, his condition was improved.
Post-treatment:
Soetiono Soetiman's MMSE score is higher than before. His emotional state is almost normal. The blood pressure and blood sugar levels are under control. The cardiac murmur has been alleviated. There was a 1 degree murmur of puffing character in the mitral valve systole. The examination of sensation was normal. The skin pigmentation below both ankle joints was alleviated obviously. The renal function is better than before. The creatinine has been reduced.
