Dr. Sloan returns to the clinic accompanied by her brother (Mr. Jacobson), sister-in-law and daughter-in-law. Since her last appointment in 8/84 Dr. Sloan has been living with her brother and sister-in-law in Blowing Rock, NC-." According to Mr. Jacobson,' Dr. Sloan continues to, display evidence of memory loss. Specifically she will repeat herself frequently during a conversation and has difficulty with her orientation to time. Otherwise she remains independent in her physical ADL's except her frequency of bathing has decreased to approximately one tub bath per month; she sponge bathes approximately two or three times a week. There has been no wandering, incontinence or, violent behavior. The family's major concern is the vulnerability of Dr. Sloan to financial exploitation. At this time no one has power of attorney; however Dr. Sloan's lawyer and banker are assisting in her financial matters. There continues to be question regarding the possibility of inappropriate use of Dr. Sloan's liquid assets by her oldest son.

According to Dr. Sloan, she continues to admit to mild memory loss. She also seems to appreciate the concern regarding the management of her financial affairs as expressed by her family. She has no other specific physical complaint and denies any symptoms of depression.

Objective: Dr. Sloan is well dressed and acts in a very polite manner. Her speech was fluent and coherent. There was no evidence of delusional or hallucinatory thoughts. Her mood is happy and content and her affect is appropriate. On cognitive testing she scored 30/30 on the Folstein and had no errors on the SPMSQ.

Assessment

1. Dementia: the family consistently provides historical evidence of a significant cognitive impairment. Despite Dr. Sloan's performance on the screening mental status instruments I believe that there is a very high likelihood that she has an early dementia which should become manifest with more comprehensive mental status testing on her next visit. In the meantime I share the family's concern regarding Dr. Sloan's potential vulnerability to financial exploitation. Consequently I have encouraged Dr. Sloan and her family to discuss plans for more formal monitoring of her financial affairs (i.e. power of attorney or guardianship arrangements if needed) at least for the next one year.

Plan

1. The family is encouraged to purchase The 36 Hour Day and ADRDA information.

2. Dr, Sloan is spending the winter in Florida. with her brother and plans to return to North Carolina in 5/85 at which time arrangements are being made for her to move in with her youngest son and daughter-in-law.

3. A follow up appointment for more comprehensive neuropsych. testing is to be arranged in 5/85.

Peter M. Becker, M.D.