Chapter Three

“possible Alzheimer’s”


Initial neurologist’s report, Jan. 16, 2001

From the medical records of Dr. Janet Saunders:

History of Present Illness: The patient is a 71 year-old right-handed retired married white male who has noticed periods of confusion or problems with his memory. His wife feels that this has been progressive over 23 years. …He has always had difficulty remembering proper names but recently has had problems with any type of proper noun, to the point where he will use a lot of pronouns. This increases if he is under any type of stress or becomes flustered, especially in a situation where there are multiple people trying to talk to him or any type of distraction going on. His wife has even notices that he has difficulty with focusing on his driving and handling the car correctly if he becomes too distracted. This is partially due to the fact that he has some problems with hearing. She has noticed that he has had problems with math and basic other things, recently noted because they are building a house. … He really has no other neurological complaints except for loss of hearing and loss of smell….


Mental Status: The patient is neatly and appropriately dressed and groomed. He is friendly and cooperative, and his behavior is appropriate. I have a problem talking loud enough for him to hear me, and he responds to that quite appropriately. This did not seem to be a significant barrier to communication. He was able to name, repeat, read, and write without difficulty. He was able to follow a simple three-step command. There was no evidence of delusions, hallucinations, or illusions. His affect was full range and appropriate to context, and his mood is clearly anxious today.

He could name the governor, the lieutenant governor, and president elect but not the vice president elect. He could name Clinton with his vice president and Bush, but needed several clues to remember Reagan. He was able to spell “world” forwards and backwards. He could not perform two-step math and he could not do serial sevens which were given as 93-84-78-71-66. He was given three two part objects and after more than 15 minutes of intervening distraction he was able to remember “Arthur Clarke”, “722 Broadway”, and “yellow Cadillac” correctly.

(Nerve tests normal, deleted.)


Impression:

1. Possible early dementia of the Alzheimer’s type.
2. Status post polio.
3. Degenerative joint disease.

Discussion: The patient has had an MRI of his brain which is actually looking very nice for his age. He had multiple laboratory studies done which were all fine… Although the findings are somewhat subtle, I do think he may have very early problems with his memory in that I would expect for a person who was able to supervise complex mechanical machinery to have much less of a problem doing calculations. Overall I think his problems are extremely slight, but I think there is an advantage in starting treatment early on. I will advise him to start with vitamin E 1000 mg p.o.q.d. and will also suggest that we try a course of Exelon, warning him about nausea and vomiting. I will plan to see him back in about two months to see how he is doing with this.