This case study summarizes the behavioral symptoms of an 83-year old woman named Hilda who has been diagnosed with Alzheimer's disease. Hilda lives with her daughter and family. She was initially prescribed Memantine and antipsychotics 5 years ago when she began experiencing delusions and memory loss. Currently, her MMSE score is 11/30 indicating moderate to severe dementia. The most concerning behavioral symptom for her family is that she drinks water from the toilet. The document discusses how damage to brain areas like the hippocampus can cause memory issues and problems distinguishing objects in Alzheimer's patients. It was determined for Hilda that reminding her of drinking water from a fresh bucket instead of the toilet by appealing to her semantic memory could help resolve the

1. Behavioral symptoms in
Alzheimer´s disease: a case study
María José Gálvez Pérez
Psychologist

2. Case report
• Hilda is a patient that attends KINTUN day care center in urban
Santiago de Chile.
• She is 83 years, widow, 2 sons. Lives with her daughter, son in law
and grand children. During her life she lived in rural places at the
farm
• 5 years ago she started with delusions and memory loss, at that
time her Geriatrician prescribed Memantine and some
Antipsychotics with Alzheimer´s disease possible diagnosis. In
neuropsychological assessment she had MMSE: 19/30. Now her
MMSE: 11/30, with a moderate to severe Dementia.
• The most upsetting behavioral symptom for the family is that she
is that she drinks water from the toilette and also washes her
face with that water

3. Alzheimer disease
As a Dementia, or Major Neurocognitive Disorder (DSM5) the
progression of the disease is predictable, with problems at first with
instrumental activities of daily living, then basic activities of daily living
and finally depending on others to survive.
Executive functions from frontal areas such as money management, left
temporal areas in communication and transport start to deteriorate.
Memory loss involving activities of daily living and apraxia with
subcortical connections and motor areas: such as dressing, writing
appear to damage in their connections to parietal areas.
Then amnesia and agnosia, as our patient who doesn't seem to
understand what the toilet it is for.

4. First
Progressive
damage
Later
Progressive
damage

5. Hippocampus damage
• As we saw in the class, the hippocampus is
critical for new memories, named episodic
memory.
• The recall of semantic doesn´t depend on
hippocampus.
• In Alzheimer disease first the person don´t
remember recent events, then in moderate
stage don´t remember some people and the
use of some objects.
• Hilda used to live in a farm, with no toilet,
and she took water from a water well, maybe
that is what she thinks when she take water
from the toilet.

6. Perceptual experts • We saw in the class that the
information from the retina is much
more less tan the information from
our perceptual experience. And what
we expect to see. Things being
already percept would be faster in
the connection between retina,
thalamus and visual primary area.
• Thalamus will translate this
information with the brainstem by
serotonin, acetylcholine and
norepinephrine
Hilda with me. When I told her that we could
take a selfie, she told me what a nice mirror.

7. Solving the Problem
• Based in Gitlin´s model of non
pharmacologic management of
Behavioral symptoms in dementia,
we counseled the family to
maintain the toilet close and have
fresh water in a bucket (semantic
memory) making the solution
appropriate for what we thought
she was thinking.
• And wonderfully she changed her
behavior and started using the
bucketJAMA. 2012 Nov 21;308(19):2020-9

8. How this course help me?
• This course helped me to understand the phenomena around me in terms of
learning more about the ways my patients with Dementia perceive the world.
• And also, how lucky we are as human beings. This because the neural pathways
can be affected for many reasons from intra uterus life to accidents, exposure to
some traumas or neurodegenerative problems.
• Also the laboratories helped me to localize the parts of the brain that I haven't had
access to them in real brains.
• This course help me to feel comfortable in some medical discussions, before that I
always thought that my knowledge's were so basic.
• Finally, I really appreciate this course and the dedication of professor Mason.

9. Thank you!
Hilda and her friends in the
day care center.
“Living well with Dementia”