Training Title 50
Name: Harold Brown
Gender: male
Age:60 years old
T- 98.8 P- 74 R 18 134/70 Ht 5’10 Wt 170lbs
Background:
Has bachelor’s degree in engineering. He dates casually, never married, no children. Has one
younger brother. Sleeps 7 hours, appetite good. Denied legal issues; MOCA 28/30 difficulty with
attention and delayed recall; ASRS-5 21/24; denied hx of drug use; enjoys one scotch drink on
the weekends with a cigar. Allergies Dilaudid; history HTN blood pressure controlled with
Cozaar 100mg daily, angina prescribed ASA 81mg po daily, valsartan 80mg daily.
Hypertriglyceridemia prescribed fenofibrate 160mg daily, has BPH prescribed tamsulosin 0.4mg
po bedtime.
Symptom Media. (Producer). (2017). Training title 50 [Video].
https://go.openathens.net/redirector/waldenu.edu?url=https://video.alexanderstreet.com/wa
tch/training-title-50

NRNP 6635 Case History Report – Week 10: Neurocognitive and Neurodevelopmental Disorders
Training Title 50: Harold Brown
1. Introduction
Patient: Harold Brown, 60‑year‑old male.

Context: Case study from Symptom Media video (2017).

Clinical Focus: Neurocognitive disorders (attention, recall deficits) and neurodevelopmental screening in older adults.

Importance: Highlights how subtle cognitive changes in aging adults may overlap with medical comorbidities and require careful evaluation.

2. Demographics and Background
Age: 60 years old.

Gender: Male.

Vitals: T 98.8, P 74, R 18, BP 134/70 (controlled).

Height/Weight: 5’10”, 170 lbs (BMI ~24.4 → normal).

Family: One younger brother; never married, no children.

Education/Occupation: Bachelor’s degree in engineering.

Lifestyle: Dates casually, enjoys one scotch and a cigar on weekends. Sleeps 7 hours nightly, appetite good.

Medical History:

Hypertension (controlled with Cozaar 100 mg daily).

Angina (ASA 81 mg daily, valsartan 80 mg daily).

Hypertriglyceridemia (fenofibrate 160 mg daily).

Benign prostatic hyperplasia (tamsulosin 0.4 mg nightly).

Allergies: Dilaudid.

Psychiatric/Substance History: Denies drug use; occasional alcohol and cigar.

3. Psychosocial Stressors
Family Dynamics: Limited support system (single, no children).

Occupational Identity: Retired engineer, possible adjustment to retirement.

Social Isolation: Casual dating but limited long‑term relationships.

Medical Burden: Multiple chronic conditions requiring daily medications.

Cognitive Concerns: Subtle deficits in attention and recall may affect independence.

4. Clinical Presentation (Neurocognitive Features)
Reported Symptoms:

MOCA score 28/30 → mild difficulty with attention and delayed recall.

ASRS‑5 score 21/24 → suggests significant ADHD‑like symptoms.

Behavioral Indicators:

May struggle with sustained attention.

Memory lapses (delayed recall).

Risk Factors:

Age (60).

Hypertension and vascular disease (angina).

Hypertriglyceridemia → vascular risk for cognitive decline.

Family support limited.

5. Mental Status Examination (MSE)
Appearance: Well‑groomed, normal weight.

Behavior: Cooperative, calm.

Speech: Normal rate/volume.

Mood: Neutral.

Affect: Appropriate.

Thought Process: Logical, coherent.

Thought Content: No delusions or hallucinations.

Cognition: Mild deficits in attention and recall.

Insight/Judgment: Fair, recognizes medical needs.

6. Differential Diagnosis
Mild Neurocognitive Disorder (MCI): Subtle deficits in memory and attention without major functional impairment.

Attention‑Deficit/Hyperactivity Disorder (Adult ADHD): ASRS‑5 score suggests possible lifelong attention difficulties.

Major Neurocognitive Disorder (Dementia): Less likely given high MOCA score, but must monitor progression.

Vascular Cognitive Impairment: Hypertension, angina, hyperlipidemia increase risk.

Depression/Anxiety: Can mimic cognitive deficits.

7. Diagnostic Considerations (DSM‑5)
Mild Neurocognitive Disorder:

Evidence of modest cognitive decline.

Does not interfere with independence.

Major Neurocognitive Disorder:

Significant decline interfering with independence.

Adult ADHD:

Persistent pattern of inattention and/or hyperactivity.

Symptoms present since childhood, impair functioning.

Harold’s Case:

MOCA near normal → mild cognitive impairment.

ASRS‑5 high → possible ADHD traits.

8. Assessment Tools
MOCA (Montreal Cognitive Assessment): Cognitive screening.

ASRS‑5 (Adult ADHD Self‑Report Scale): ADHD symptoms.

MMSE (Mini‑Mental State Exam): General cognition.

Neuropsychological Testing: Detailed cognitive profile.

PHQ‑9/GAD‑7: Depression/anxiety screening.

Vascular Risk Assessment: Evaluate impact of hypertension, hyperlipidemia.

9. Treatment Plan
Pharmacological:

Optimize vascular risk management (HTN, triglycerides).

Consider ADHD medications (stimulants or non‑stimulants) if diagnosis confirmed.

Avoid polypharmacy interactions.

Psychotherapy:

CBT for attention and coping strategies.

Psychoeducation about cognitive health.

Lifestyle Interventions:

Cognitive training exercises.

Physical activity for vascular health.

Nutrition counseling (low fat, heart‑healthy diet).

Sleep hygiene.

Supportive Measures:

Family involvement (brother).

Social engagement activities.

Community support groups.

10. Monitoring and Follow‑Up
Regular cognitive screening (MOCA, MMSE).

Monitor vascular health (BP, lipids).

Medication adherence checks.

Neuropsychological reevaluation if symptoms progress.

11. Challenges
Diagnostic Ambiguity: ADHD vs. mild cognitive impairment.

Medical Burden: Multiple chronic conditions.

Social Isolation: Limited family support.

Stigma: Mental health stigma in older adults.

12. Ethical and Cultural Considerations
Confidentiality: Respect patient privacy.

Consent: Informed consent for treatment.

Safety: Monitor for functional decline.

Cultural Sensitivity: Consider immigrant background, occupational identity.

13. Case Summary
Harold Brown: 60‑year‑old male with mild attention and recall deficits, vascular risk factors, and possible ADHD traits.

Likely Diagnosis: Mild neurocognitive disorder vs. adult ADHD.

Treatment: Optimize medical management, cognitive training, psychotherapy, lifestyle interventions.

Outcome Goal: Maintain independence, prevent progression, improve quality of life.

📝 Quiz (15 Questions)
Multiple Choice – Select the best answer.

What is Harold’s age? a) 58 b) 60 c) 62 d) 64

What is Harold’s highest education level? a) High school diploma b) Associate’s degree c) Bachelor’s in engineering d) Master’s degree

What is Harold’s marital status? a) Married b) Divorced c) Never married d) Widowed

How many siblings does Harold have? a) None b) One younger brother c) Two sisters d) Three siblings

What was Harold’s MOCA score? a) 25/30 b) 26/30 c) 28/30 d) 30/30

What difficulty was noted on MOCA? a) Language b) Attention and delayed recall c) Orientation d) Visuospatial

What was Harold’s ASRS‑5 score? a) 15/24 b) 18/24 c) 21/24 d) 24/24

Which condition is suggested by ASRS‑5? a) Depression b) ADHD traits c) Dementia d) Anxiety

Which medical condition does Harold have? a) Diabetes b) Hypertension c) Asthma d) Epilepsy

Which medication does Harold take for hypertension? a) Cozaar b) ASA c) Fenofibrate d) Tamsulosin

Which medication does Harold take for hypertriglyceridemia? a) Cozaar b) ASA c) Fenofibrate d) Valsartan

Which medication does Harold take for BPH? a) Cozaar b) ASA c) Tamsulosin d) Fenofibrate

What lifestyle factor may increase vascular risk? a) Weekly scotch and cigar b) Daily exercise c) Vegetarian diet d) No alcohol use