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The patient currently lives at home and receives assistance from her younger son and daughter-in-law. The patient has completed 12 years of formal education. She is retired having worked in a molding plant and as an office worker. She is widowed (13 years) and also recently lost her boyfriend in July of 2007, which most likely made her anxious about being alone. Physical examination revealed a well-nourished female. She is 62 inches tall and weighs 175 lbs. Blood pressure was 150/88. Skin condition: no open areas turgor good. Bowels move every one to two days. There is no history of UTI. She has some arthritis in her hips and uses a walker to ambulate. She has discussed the possibility of hip replacement surgery with her physician, but due to the dementia diagnosis the family wished to discuss this further with her. There were no other abnormal findings on physical examination. MMSE was 18. She was very pleasant and cooperative throughout the evaluation. The patient wears eyeglasses and she wore these during the evaluation. I did not observe any significant difficulties with vision or hearing that would interfere with the test administration or with her performance. Thought processes were logical and goal directed. There was no evidence of a disorder of thought process or content. Expressive language was fluent and within normal limits for volume and prosody. I did not observe significant word-finding difficulties in her conversational speech during this evaluation, but she did display word-finding difficulties on a measure of confrontation naming. The patient's mood was slightly depressed. She reported that she was very distressed over her eldest son's actions and that she had been "down in the dumps" lately over this. She has been drinking alcohol more frequently to relieve her anxiety. She did endorse any thoughts of harming herself.

The patient does report some occasional difficulties with her memory, but does not believe they are severe. She does occasionally miss things and misplace things but she also uses lists and reminders to assist her. The patient does have a history of depression anxiety and takes medication for this. The patient's son reported to me that he does not believe that his mother has severe memory difficulties. He added that she does not frequently get lost driving, does not forget to turn off the stove when cooking, and is capable of paying her bills and taking care of herself.

Current concerns are the patient's hypertension, depression, and dementia. She is scheduled for formal evaluations to document the extent of her cognitive and mood problems and those reports are pending. Given her history of possible CVA it is recommended that her medications be reevaluated and that she be placed on a healthy heart diet. The need to control her hypertension was discussed with her son and it was agreed that he would assist his mother in monitoring her diet and alcohol intake. A referral to mental health is suggested to help manage her depression. Nursing will follow.