Introduction: A 74 year old patient, single, formerly working in sociomedical surrounding, living alone in sheltered housing, is hospitalized for depressive state, initial cognitive disorders, feelings of persecution and «syndrom of Diogenes». Neuropsychological evaluation and first steps of neuropsychological therapy are performed. The presentation will be illustrated by video passages of the talks.
Methods and Material: Neuropsychological evaluation highlights moderate memory difficulties with regard to verbal material (test of free/cued recall with 16 items; Grober and Buschke procedure), moderate executive disorders (e.g. poor verbal fluency; lack of flexibility; complete failure at the Trail making test part B; verbal perseverations), moderate difficulties in calculation and attention (Code of the WAIS III), mild linguistic difficulties (mild dysorthography) and temporal disorientation, with good nonverbal memory capacities (e.g. in the Doors and people test), practic and gnostic capacities and reasoning (Scale of Mattis). The depression and anxiety scores of the HAD scale are significantly elevated. Neuropsychological evaluation and cerebral imagery (advanced state of small vessel disease, cortico-subcortical atrophy, bitemporal, medial and left internal) evoke a picture of dementia of vascular and degenerative etiology of mild gravity (CDR* = 1).
After neuropsychological testing, the patient was seen four times, in order to plan and set up neuropsychological rehabilitations strategies as for example cognitive mnemonic strategies, like the use of an agenda. Furthermore, an opportunity has been offered to the patient to talk about her problems.
Results: The patient uses the agenda in a satisfactory way (locates herself in time more easily). However, she uses this new device rarely and continues with her own small diary, yet irregularly. In the course of the sessions, more time is allocated to free discussion, to approach cognitive problems the patient is confronted with in daily life activities. In a standardized fashion, these problems are evaluated by an instrument measuring health-related quality of life.
Conclusion and Outlook: The possibilities for neuropsychological therapy were evaluated. For an effective use of mnemonic strategies, several weeks of therapy are required. Actually, the patient, having returned home, is followed by her treating doctor in town, a psychiatrist and a occupational therapist. For further treatment success it would be necessary to continue the integration of the mnemonic strategies (the patient having already the "good reflex" of using a diary) and to approach the cognitive and emotional problems of the patient in a structured neuropsychological therapy. One main concern of the patient is not to lose her memories. In fact, how can we approach memories when we are forgetting them?
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