Thank you very much for referring Ms. Choi for geriatric assessment. The main concern is that of decreased cognition.
She is an 85-year-old lady who was born in China and came to Canada for over 30 years. She is married and lives with her husband in a co=op apartment. They have 5 children, 3 sons and 2 daughters. One of the sons is in Toronto and one of the daughters is in Toronto as well. she speaks Cantonese. She is a retired part-time cleaner. She had no formal education.
Her son, Mr. Choi is present with her for the interview today. She complained about having a decline in her cognition for over 5 years. She is forgetful with conversations and has decreasing comprehension. It is getting worse over time. There are no hallucinations or delusions. There is no history of getting lost. She recognizes her family and friends. She has no history of late payment for bills. She does groceries and laundry.
She went to a restaurant once and left her purse there. She returned and then found it. She had paid for the meal but forgot to take the purse with her. She has also left an umbrella on the bus. She sleeps 5-6 hours at night and is easily awakened. She wakes up in the early morning about 4:00-5:00 a.m. She takes naps in the day for 0.5-1 hour but not every day. She had dropped her appetite and weight. She has lost about 7-8 pounds over more than 2 years.
She is the caregiver to her husband who is 95 years old. He walks with a Rollator walker. He has macular degeneration and requires help. He has Meals on wheels and also CCAC twice a week. She said that her husband’s temper is bad because of his illness. He takes it out on her and so she is not happy. Her mood is low.
Last year she had fallen twice in the TTC or subway. She fell...
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...sents with subjective symptoms of decreased cognition but the MMSE is well maintained within normal range with no evidence of short-term recall problems. The clock drawing test is fairly normal. The findings do not suggest Alzheimer’s disease or other forms of dementia. I would think that the incidences of forgetting belongings may well be a sign of caregiver stress and possibly depression, as she is stressed out on providing care to her elderly husband who is not in a good mood either because of his own health problems. I have offered a trial of antidepressants, in particular Remeron for her but she declined. I have reassured her that there is no evidence of Alzheimer’s disease and the MMSE score is very good considering that she has no formal education.
I have not made an appointment for her to come back to see me, and thank you very much for referring this lady.