Chapter Five

“…clearly delusional…”

Neurologist’s report

May 6, 2002

From the records of Janet Saunders, MD

Hospital room examination

MENTAL STATUS EXAMINATION: The patient is somewhat inappropriately dressed in that he has taken off his pajama top and is walking around with just his bottoms on. Otherwise, he is appropriately groomed. He is not completely cooperative and is difficult to distract. He does not follow directions easily. He is quite agitated while I am trying to talk to him. He got up and started walking around the room and actually walked out of the room. He would continually mumble things to himself and when I would ask him questions, at times his answers would be completely irrelevant. When I could get him completely focused, he could recognize that he was probably in Anchorage but otherwise he ... immediately ...would tell me he was in his home town…

It is very difficult to get him to function and focus his attention. He is disoriented to being in the hospital. I could not get him to give responses to orientation questions as far as time was concerned. He is, however, able to repeat and name fairly well and actually could look at my watch and tell me the correct time. He is clearly delusional, thinking that he is at work and trying to get some work done. His affect is constricted and his mood is quite anxious and irritable. His attention and concentration are practically nil.

DISCUSSION: I suspect the patient's condition has deteriorated secondary to his pain medications and lack of sleep. Tonight, I am going to try to get him to sleep first using IV Haldol and if that doesn't work we can try IV benzodiazepines. It is always a little bit risky using benzodiazepines in patients with dementia as they can have a paradoxical effect with the sedation actually making the patient more agitated. I do think that if we can get the gentleman to have a good night's sleep for a couple of nights, he probably will begin to recover closer to his baseline......"

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