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Malaz Boustani, MD, MPH Network Director, Indianapolis Discovery Network for Dementia

Dementia, Orthostatic Hypotension, & Anxiety in a Young Female!. Malaz Boustani, MD, MPH Network Director, Indianapolis Discovery Network for Dementia Assistant Professor of Medicine, IU School of Medicine Research Scientist, Regenstrief Institute, Inc. Mrs. LS. Jan 2009 :

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Malaz Boustani, MD, MPH Network Director, Indianapolis Discovery Network for Dementia

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  1. Dementia, Orthostatic Hypotension, & Anxiety in a Young Female! Malaz Boustani, MD, MPH Network Director, Indianapolis Discovery Network for Dementia Assistant Professor of Medicine, IU School of Medicine Research Scientist, Regenstrief Institute, Inc November 16, 2010

  2. Mrs. LS • Jan 2009: • 56 yrs WF with 26 months of memory loss & decline in social and daily function • 2006 Dx with MCI? • 2007 Dx with AD • 2008 Dx with depression, anxiety features • New Dx of OH • Nov 2010: • Seizure like Sx in UE • LOC • Facial weakness • Hospitalization • Risk factors: • 12 yrs education • No FH of Dementia • No head trauma • No delirium • No depression • No def Ach • No HTN, No DM, No hyperlipidemia • No ETOH

  3. Jan 2009 • Neuropsych test: • VF: 4/18 (> 2SD) • Naming: 3/15 (> 3SD) • CP: 8/11 (2SD) • VM: • T1: 2/10 (>3SD) • T2: 3/10 (>3SD) • T3: 0/10 (>3SD) • D: 0/10 (>3SD) • NVM: 3/14 • Trail A: 33’’ (1SD) • Trail B: 168’’ (2SD) • GDS: 8/30 (1SD) • Examination: • CAM – • OH +++ • PE WNL • CN WNL • Strength WNL • Sensory WNL • Reflex WNL • Gait WNL • Parkinson • Slight tremor • R>L rigidity??

  4. Jan 2009 – Feb. 2009 • Medication: • Galantamine 8 mg qd • Lexapro 20 mg qd • Fosamax 70 mg qW • Vitamin Plus • Anticholinergic Burden: 0 • Cleveland Clinic: • MRI: WNL • LP: WNL • EEG: WNL • EPO 4: NA • PMH: • Polio • Depression • Osteoporosis • MRI: • Volume Loss in Parietal and Temporal Lobes bilaterally • Greater in bilateral frontal lobe with ex vacuodilatation of temporal horn • Lab: • Chem 19 WNL • TSH WNL • B12 WNL • RPR WNL • Dx: • Probable AD (Mild to Moderate) • Did not tolerate ChEI • Start Venlafaxine

  5. Feb 2009 – Nov 2010 • Current Medication: • Midodrine • Venlafaxine • Namenda • PPI • OH: • Better • Anxiety: • Worse • Myoclonus: • Worse in 3-4 weeks • ADL: • Dependent in all I-ADLs • Dependent in 2/7 B-ADLs

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