Medical Emergencies · patient case question
When should this patient's appointment be scheduled?
Patient case: Elderly man with Alzheimer disease and a symptomatic upper left molar
Patient: Male, 78 years old
Chief complaint: “His tooth has been hurting him and his face is swollen.” Reported by the wife, who accompanies him.
Background: Alzheimer disease, moderate stage. Medication: donepezil. His wife attends every appointment and manages his daily care.
Current findings: Periapical radiograph shows tooth #15 lying on its side (slanted/impacted) with an associated radiolucency. Swelling and pain localised to #15. Patient is pleasantly confused and defers all questions to his wife.
Show answer and explanation
Correct answer: D. Morning
- A. Late afternoon is squarely in the sundowning window.
- B. Evening is the worst possible choice for a demented patient.
- C. Cooperation is already declining by early afternoon.
- D. CORRECT. Patients with dementia function best EARLY in the day. Confusion and agitation characteristically worsen as the day progresses — the phenomenon called SUNDOWNING. Short morning appointments give the best cooperation.
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