Alzheimer’s Disease

Roger’s Story

Roger, a 71-year-old man, was referred to a psychiatrist by his primary care doctor for symptoms of depression that had not responded to medication. Roger’s wife reported that he had begun to change at age 68, about a year after his retirement. He had stopped playing golf and cards, which he had enjoyed for decades. He no longer looked forward to going out of the house, and he refused to socialize. Instead, he sat on the couch all day and watched TV or napped. His wife said he was sleeping 10-13 hours a day instead of his normal seven hours.

His wife had become worried that retirement had left Roger depressed, and she had mentioned her concerns to their primary care doctor. Their doctor agreed and prescribed an antidepressant. Roger’s symptoms did not improve on the medication, and the doctor then referred him for a psychiatric evaluation.

Roger’s past psychiatric history was noted because one of his younger brothers had major depression that was treated with psychotherapy and antidepressant medication. His mother had developed dementia in her 70s.

Roger had graduated from college with a degree in business, had a successful career as a corporate manager and retired at age 67. He and his wife had been married for 45 years, said there were no major marital problems, and had three children and four grandchildren, who were all in good health. Before this, he had been outgoing, energetic and well organized.

Roger had high blood pressure and high cholesterol and was taking medication for these conditions. The exam showed he was alert and cooperative and had steady but slow speech. Roger had a limited range of emotional expression, denied feeling sad or guilty, but felt he had retired too early. He was aware that his wife was concerned and agreed that he had less energy and was less active than in the past. He blamed these changes on his retirement.

During the exam, Roger could name the year but not the month or day of the week for his appointment. He remembered one of three objects in two minutes, performed three of five subtractions correctly, named four common objects correctly, and repeated a complex sentence without error. He was able to draw the fact of a clock and place the numbers correctly, but he was not able to correctly place the hands at 10 minutes after two.

Roger was diagnosed with Alzheimer’s disease. He had a 3-year history of gradual social withdrawal. He has a family history of depression in a brother and late-life dementia in his mother. The main symptoms were slowness, lack of concern about his decline and increased sleep. The exam showed problems in memory, concentration and math, as well a trouble with clock drawing.