Case Study
Patient Demographic: Client Age: 74 Sex: Female Gender: Female Sexuality: Heterosexual Ethnicity: Caucasian Relationship Status: Divorced Counseling Setting: Community Mental Health Center Type of Counseling: Individual and psychoeducation Presenting Problem: Memory impairment Diagnosis: Mild Neurocognitive Disorder (MND) Unspecified with Behavioral Disturbance (apathy and mood disturbance) 799.59 (R41.9)
Mental Status Exam: Mental Status Exam: The client is appropriately dressed and cooperative. She is tearful at times and often glances over at her daughter when she is unsure of how to respond to a question. The client denies suicidal and homicidal ideations. She is oriented to the day, month, and year, but she could not recall the date or place. She recalls the city with prompting. The client’s sleep is fair, and her appetite is normal. She reports feeling sad most of the day, every day. To date, medical procedures used to determine the etiology of the client’s cognitive impairment have been inconclusive. She awaits an appointment for a positron emission tomography (PET) scan, which can help determine the presence of brain activity associated with Alzheimer’s disease. She denies substance use and says that she is a social drinker. Her judgment and awareness are fair, and she denies audio and visual hallucinations. Fam
Presenting Problem: You work in a mental health center and are conducting an initial assessment on a 74-year-old Caucasian female. The client and her daughter arrive today with a copy of the client’s recent neuropsychological evaluation. The evaluation shows cognitive functioning deficits, and the neuropsychologist has diagnosed the client with mild neurocognitive disorder (MND). The client and her daughter fear that her memory issues could worsen and impact her independence. The daughter has seen a gradual decline in the client’s memory, which coincides with episodes of depression. The client expresses embarrassment over her memory issues and states, “remembering the simplest things—like doctor’s appointments or paying bills—has started to become more and more difficult.” She states that she no longer participates in things she once enjoyed, including her book club, church services, and fitness classes.
Other Contexts:    ily and Work History: The client divorced nearly 15 years ago and has lived alone since. She has two adult children and four grandchildren who all live locally. She reports experiencing depression and anxiety for most of her life. She currently takes an antidepressant and has done so for years. The client’s career was in school administration, where she dedicated nearly 30 years of service until retiring 6 years ago. She reports that retirement caused an increase in depression as she grieved the “loss of (her) identity.” The client’s mother had Alzheimer’s disease, which placed significant stress on the client and her father. The client’s sister is diagnosed with bipolar disorder, and there are no other noted mental health or substance use disorders in the family.  The client’s neuropsychological testing scores on a normal distribution place her one standard deviation below the mean

Question: The client’s neuropsychological testing scores on a normal distribution place her one standard deviation below the mean. The client scored as well as or better than approximately what percent of the normed population?
(A): 3%
(B): 85%
(C): 48%
(D): 16%

Correct Answer: 16%
Explanation: The client scored one standard deviation below the mean. This signifies that she scored as well as or better than 16% of the population because the percentage of the normed population that scores plus or minus one standard deviation is 68% and the percentage that scores greater than one standard deviation is an additional 16%. In that case, an individual who scores less than one standard deviation of the mean would be scoring as well as or better than the remaining 16% who scored more than one standard deviation less than the mean. The normal curve is symmetrically distributed. Almost two-thirds of the scores lie one standard deviation from the mean. Roughly 3% of the population tested scored two standard deviations below the mean. Generally, standardized tests have a mean score of 100. With a mean of 100, one standard deviation below the mean would be a score of 85 rather than 85% (whereas one standard deviation above the mean would be a score of 115). If the client scored at least two standard deviations below the mean, she would likely receive the diagnosis of major neurocognitive disorder. Therefore, the correct answer is (B)
Competency: intake, assessment, and diagnosis