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: The client presents today with a blunted affect and an irritable mood. The daughter accompanies the client and states that the results of the client’s recent PET scan show changes in the brain that may indicate Alzheimer’s disease. You process the results with the client and her daughter and provide psychoeducation on cognitive impairment, including counseling risks, benefits, and limitations. The client would like to focus on improving psychosocial issues associated with her cognitive impairment.  You ask the client to share her previous experiences participating in her church, book club, and fitness classes

Question: You ask the client to share her previous experiences participating in her church, book club, and fitness classes. What are you trying to accomplish?
(A): Underscore the value of renewing and maintaining social support and exercise.
(B): Identify any interpersonal stressors or trauma that caused her to discontinue these activities.
(C): Assess individualized belief systems that may interfere with adherence to counseling.
(D): Determine the client’s level of cognitive functioning before she discontinued these activities.

Correct Answer: Underscore the value of renewing and maintaining social support and exercise.
Explanation: The primary purpose of asking the client to share her experiences of attending church, going to her book club, and taking fitness classes is to underscore the value of renewing and maintaining social support and exercise. The client is experiencing a decline in cognitive functioning but also exhibits associated behavioral and emotional disturbances. Supportive social relationships and exercise are associated with an overall increase in one’s quality of life and decreased experiences of depression and anxiety. It is unnecessary to determine the client’s cognitive functioning before discontinuing activities because we already have evidence of a modest cognitive decline from a previous level of functioning. Because the client is adhering to treatment thus far, individualized belief systems do not need to be examined. Lastly, cognitive impairments rather than interpersonal stressors or trauma are linked to the client’s discontinuation of the activities. Therefore, the correct answer is (C)
Competency: counseling skills and interventions