OCCUPATIONAL ENGLISH TEST
WRITING SUB-TEST: Medicine
TIME : READING: 5 MINUTES
WRITING : 40 MINUTES
Read the case notes below and complete the writing task which follows.
Notes:
Your long-term patient, Mrs Walshman, has attended your GP surgery with her daughter. Both are concerned about Mrs Walshman’s memory.
Patient: Mrs Patricia Walshman (D.O,B: 10/07/1933)
Address: 24 Kenneth St, Newtown
Marital status: widowed, 5 adult children
Next of kin: Christine – daughter
Diagnosis: osteoporosis. Dementia (? Early stage Alzheimers)
Social background: widowed 40 yrs, lives alone, children within 10 km radius
Medications: osteo vit-D 1000 IU, atorvastatin (lipitor) 20 mg mane, ibuprofen (Bruten) 200 mg prn, metoprolol 100 mg b.d, paracetamol (panadol 500 mg) prn
Past medical history
2010 – 2016 Regular GP visits to this clinic, pathology, BP – stable
1 October 2017 Fall – bruised nose only, X-ray – NAD, will begin to take it easy, slow down
8 November 2017
⦁ Occupational therapist (OT) home assessment. Evaluated shower rails, ramp, bed ok. R/V 4-6 months
⦁ Discussed shower with OT. All ok
⦁ Shower every other day to lessen likelihood of falls
⦁ Community support: home care provided by local council. 1 / fortnight
26 March 2018
⦁ BP 145 / 85
⦁ FBE: U&E, LFTs – all NAD
⦁ Total cholesterol 4.8 mmol/l (<5.5)
⦁ HDL cholesterol 1.4 mmol/l (0.9-2.2)
⦁ *LDL cholesterol 2.9 mmol/l (<2.0)
⦁ Triglycerides 1.1 mmol/l (0.5-2.0)
⦁ LDL/HDL 2:1
⦁ Chol/HDL 3:4
⦁ *Vitamin D < 54 (60-160 mmol/l)
Discussions:
⦁ spare scripts – not filling them or not taking medication regularly
⦁ Assures me she is taking medication regularly
⦁ Suggested Webster pack (a sealed weekly calender pack designed to help people take their medication correctly), was reluctant, promised to adhere to medication regime
⦁ Review 2 months, post-pathology
1 August 2018
⦁ BP 130/70, vit and lipids within normal range
⦁ Medication issue resolved
⦁ Daughter with pt, both want to discuss memory issues
⦁ Poor memory noted ++ e.g. forgetting hairdresser appointments, dinner engagements, missing social events. Behavioral changes, decision making issues
Mini memory assessment:
⦁ Poor short-term memory, day & date – several attempts, no results. Month – 3 attempts. Confirmed the year correctly. Quite worried
⦁ Requested further assessment
⦁ Family history of Alzheimer’s
⦁ Asked about dementia – explained difference between Alzheimer’s disease and dementia
⦁ More assessments before diagnosis. Referred Memory clinic
⦁ R/V post-assessment
WRITING TASK
using the information given in the case notes, write a letter of referral to Dr Jones at the Newtown memory clinic, 400 Rail rd, Newtown, to provide him with your brief assessment and request full memory assessment and diagnosis.
In your answer:
● Expand the relevant notes into complete sentences
● Do not use note form
● Use letter format
The body of the letter should be approximately 180–200 words.
To
Dr Jones
Newton Memory Clinic
400 Rail Rd
Newton
19 April 2015
Re : Mrs Patricia Weishman (D.O.B. : 28/03/1930)
Dear Dr Jones,
Thank you for seeing Mrs weishman, a widow for 40 years and mothe rof 5 adult children. I am referring her to you for full memmory assessment and provide diagnosis.
Her past medical history suggests a fall June 2014 followd by occuptional therapist assessment. In decemeber 2014, She was foudn not to be complaint to medication regime. This was able to explain high LDL cholesterol and low vitamin D seen in her blood test results. After she agreed to use webster pack in February 2015, vitamin and blood lipid have normalised.
Durign her visit in April 2015, both patient and her duagther wnted to discuss about memory issues. She is forgetting hair dresser, dinner engagements and missing social events. Family was also concerned about behavioural changes and decision making issues.
On mini memory assessment it was noticed that she has poor short term memory. She could not tell data, date and month after multiple attemts. She has a family history of Alzheimer’s disease.
I would be grateful if you could perform a full memory assessment and provide a diagnosis. If you require any further information, please do not hesitate to contact me.
Yours sincerely.
Doctor
28 May 2021
Dr. Jones
Newton Memory Clinic
400 Rail Road, Newtown
Re: Mrs Patricia Welshman
DOB: 28/03/1930
Dear Dr Jones,
Thank you for seeing Mrs Welshman, a 91-year-old patient whou has presented memory issues and need a full memory assessment to determined if she has Alzheimer’s disease.
Mrs Welshman and her daughter consulted concerning about Mrs Welshman memory issues, including social meetings and dinner forgeting, as well as behavioural changes and decision making issues.
Mrs Welshman has history of dislipidemia treated with Lipito 20 mg mane; osteoporosis treated with OstVit D 1000 IU. However she has no taken medication regularly. On the last exams she had a level of LDL of 3.5 mmol/L and Vitamin D less than 20 nmol/L. She has no other relevant issue on her history.
Mrs Welshman and her family are concerned about her be suffering these symptoms, as she has family history of Alzheimer’s disease. The differenc betewen Alzheimer’s as a disease, and dementia as a symptom, have already been explained.
I would be grateful that you could do a full memory assessment and send her back to me after it.
Yours sincerely,
Dr. López
Dr Jones
Newton Memory Clinic
400 Rail Rd
Newton
19 April 2015
Dear Dr Jones
Re : Mrs Patricia Welshman
DOB : 28/03/1930
Thank you for seeing Mrs Patricia Welshman, a 85-year-old, who is widowed and lives alone for a full memory assessment and diagnosis.
Mrs Welshman and the daughter presented today to discuss memory issues. They have a family history of Alzheimer’s. The family has noted a poor memory, as well as behavioral changes and a decision-making problems. Her mini memory test assessment shows a poor day, date and month. She confirmed the year correctly, though quite worried.
On 2014, Mrs Welshman has a history of fall down and bruised her nose. The nasal bone Xray had ruled out fracture. The occupational therapist had assessed her home and recommended to reduce the shower to every other day to avoid falls. Home support was also afforded by local council.
Mrs Welshman has osteoporosis, as well as high lipids, for which she is taking OsteVit-D 1000IU and Lipitor 20 mg mane. She also takes analgesics and metoprolol.
She is a mother, widowed 40 years, lives alone and her children live far, within 10 km distance.
Based on the above, I would be grateful if you could see Mrs Welshman for a full memory assessment and diagnosis.
Please contact me should you require any further information.
Your sincerely
Doctor
Dr Jones
Newton Memory Clinic
400 Rail Rd
Newtown
04/19/2015
Dear Dr Jones,
Re: Mrs Patricia Weishman, D.O.B.:03/26/1930
Thank you for seeing Mrs Patricia Weishman who is suspected to have Alzheimer’s disease (AD) with poor short term memory. She needs your expert assessment for further management of her condition.
Today, Mrs Weishman was brought to my clinic by her daughter Christine because she was concerned about her mother’s memory issues. She has reported that Mrs Weishman is forgetting her daily routine habits alongwith behavioural changes. Christine was also concerned about her mother’s declining decision-making capacity. i performed mini-mental assessment on her which showed that she was unable to recall day & date with several attempts, she correctly recalled month in 3 attempts and year in first attempt. I made probable diagnosis of demtia related to AD which worried both of them. On addressing their concerns, I discussed nature of AD in detail and also recommended them that Mrs Weishman will need to consult a neurologist specialst for further assessment.
Mrs Weishman lives alone and have history of falls. She receives homecare from local council alongwith regular follow up from occupation health specialist. At many times she forgets to take her routine medications. I have addressed that issue regularly during check-up visits and also suggested her to use webster pack, which she has started using it recently.
Mrs Weishman is currently managed for hypercholetremia, hypertension, vitamin D deficiency. Her current medication list is attached to this letter.
Your expert evaluation will be appreciated. Please do all necessary tests and assessment for her further management.
If you have any further questions, please do not hesitate to contact me.
Yours sincerely,
GP
Dr Jones
Newton memory clinic
400 Rail Rd,
Newton
19/04/2015
Dear Dr Jones
Re: Mrs Patricia Welshman (DOB: 28/03/1930)
Thank you for accepting Mrs Patricia at Newton memory clinic for full memory evaluation in order to establish the diagnosis of dementia and possible early stage Alzheimer disease.
Today, Mrs Patricia, a widow who lives alone, came to our office with her daughter. Both of them were concerned about memory problems concerning her activities of daily living. The daughter has noticed also behavioral changes and declining of decision making capacity.
Mini mental assessment, showed that Mrs Patiricia failed to remember the date of today and the month even after several attempts. However, she was able to confirm the year correctly.
She has also a history of one fall episode in june 2014 after which she has been followed-up with Ocupational Therapist and provided a home care by local council.
Mrs Patricia has been followed in our clinic for osteoporosis for which she takes OsteVit-D 1000UI, hypertension and high cholesterol controlled with Metrol 100 mg b.d and Lipitor 20 mg mane respectively.
Of note, Mrs Patricia has a family history of Alzheimer disease.
It is my recommendation that she seek a higher level of memory assessment, thus I refer her to your practice for possible dementia related to early stage Alzheimer disease diagnosis.
Please contact me if you have any queries.
Yours Sincerely,
Doctor Mariem
Dr Jhones
Newtown Memory Clinic
400 Rall Rd
Newtown
06/28/2021
Re: Mrs Patricia Welschman, DOB 26/03/1930
I am writing to refer Mrs Welschman, a 81-years-old patient, who has osteoporosis and dementia and currently is concerned about memory problems. I am referring to you for further investigation.
Mrs Welschman is a well-known patient who has osteoporosis and dementia. The condition commenced 1 year ago when she had multiple falls for which she was assessed by occupational therapist and additionally she had concerns about forgetting to take her treatment. Mrs Welschman’s condition has been deteriorating over the time and today present with her daughter complaining of poor memory including forgetting hairdresser, missing social events and behavioral changes. Mini memory assessment was performed and showed poor short-term memory. Therefore, I am considering Mrs Welschman’s symptoms are suggestive of Alzheimer disease.
Mrs Welschman is widowed, has 5 adult children and currently is taking her prescription. Her last blood test showed LDL cholesterol increased and decreased in Vit D levels.
Would be really appreciated if you could provide a complete assessment for Mrs Welschman’s condition. If you require more information please do not hesitate to contact me.
Yours Sincerely,
Doctor
Dr. Jones
Ewtown Memory Clinic
400 Rall Rd
Newtown
19 April 2015
Dear Dr. Jones,
RE: Mrs Patricia Welshman, DOB: 28/03/1930
Thank you for seeing Mrs Welshman, a 85-year-old widow, for full memory assessment and a possible diagnosis of Alzheimer’s.
Today, Mrs Welshman and her daughter visited me to discuss Mrs Welshman’s worsening memory. She reported noticing poor memory while performing usual activities in her daily life. Her BP is 130/70. Her vitamins and lipid levels are within the range. In mini memory assessment, she showed signs of lack of short-term memory, she had trouble remembering the correct day, date and month. She needed several attempts to get it right. She only managed to get the year correctly. Common cause and difference between dementia and Alzheimer’s disease was discussed with her.
She has an ongoing problems of low Vitamin D and high levels of LDL in her blood, for which she takes OsteVit-D 1000IU and atorvastatin 20mg mane. Since she has memory problems, at times she did not take her medication, therefore in 13/02/2015 she agreed to use Webster pack to keep up with her medications. There is a history of Alzheimer’s disease in the family.
I would be grateful if you could conduct further evaluation of her memory issues as I am concerned about possible progression of her dementia.
If you have any queries, please do not hesitate to contact me.
Yours sincerely,
Doctor
Where should I type my answer to be corrected ?
Dr. Jones
Consultant
Newtown Memory Clinic
400 Rail Road Newtown
19/04/2015
Dear Dr. Jones
Re: Mrs. Patricia Welshman d.o.b 28/03/1930
I wish to refer this long time patient of mine found to have dementia, for your expert evaluation to in suspicion of Alzheimer’s disease.
Mrs. Welshman, an elderly widow, has been under my care for management of her hypertension, dislipidemia and osteoporosis. She lives alone with home care provided by the local council while her five children live within reasonable distance around her. Accompanied by her daughter for her scheduled follow-up visit, she complained of forgetting things and information. Her daughter expressed family’s concern about behavioural changes and decision making issues they have noted in their mother. Clinical examination was essentially normal while mini memory assessment revealed a poor short term memory. On enquiry, the daughter gave a family history of Alzheimer’s disease.
Mrs. Welshman is currently on OsteVit-D 1000IU, metoprolol 100mg b.d, atorvastatin 20mg, ibuprofen 200mg and paracetamol 200mg prn. During her reviews previously, she was often found to be non-compliant to her medications until last month since she has been advised Webster’s pack.
In view of the above and a family history of Alzheimer’s disease the patient and the daughter were adequately counselled. However, it would be appropriate, if she gets a detailed memory evaluation under your expert care.
Looking forward to your valuable guidance in management of Mrs.Welshman. please feel free to contact me for any additional information required.
Regards.
Yours sincerely,
G.P
Dr Jones
Newton Memory Clinic
400 Rail Rd, Newton
date
Dear Dr jones
Re Mrs Patricia Welshman DOB 28/03/1930
91 year old female with progressive short term memory loss behavioral changes and lack of discussion making capabilities .
Mrs Patricia is a 91 year old patient that lives alone with family history of alezhimer’s that comes to the office accompanied by her daughter on the 19 of April 2015, to discuss her mothers recent changes in behavior, loss of memory and lack of decision making capabilities. For which I decide to asses her memory via mini memory assessment. Test results in poor short term memory with incorrect answers to dates and months.vital signs normal with no abnormalities on physical exam. Patient is then educated in the differences of alzhiemer’s and dementias and that it is a potential cause of dementia.
Patient is widowed and lives alone. With history of osteoporosis and elevated LDL for which she is taking Ostevit-d 1000Iu daily for osteoporosis and atorvastatin 20 mg daily for hyperlipidemia as well as analgesics for pain if needed. on 19 of June 2014 patient reports a fall with no problems for which occupational therapy decided on home assement and determined it all okay. Pathology report of December 14, 2014 showed lipid panel where LDL cholesterol is elevated, and Vit D leves are decreased which correlates with spare scripts of medication patient had that month for which we advised use of a Webster pack to improve adherence to medications.
I refer this patient to you with the hope of your assistance for continued management, full memory assement and diagnosis.
Dr Marrero
Dr. Jones
Newton Memory Clinic
400 Rall Road
Newtown
19-Apr-2015
Dear Dr. Jones,
Re: Mrs. Patricia Welshman
DOB: 28/03/1930
Thank you for seeing Mrs. Welshman, a 85-year-old widow who lives alone. I am writing this referral for evaluation of her memory.
Mrs. Welshman is a long time patient of mine. Last year December 2014, her pathology report showed abnormal LDL and vitamin D level and I noticed she had spared scripts that were not filled. I discussed with her about her medication compliance and she assured me she is taking her medications regularly. I suggested a Webster pack to store her medication but she was reluctant.
Upon follow-up in Feb 2015, she agreed to use the Webster pack following worsening pathology results. Today, she came into the clinic with her daughter. Her medication has been sorted. However, her family is concerned because they have noticed poor memory of 2+ (ex: forgetting hair dresser, dinner engagement, missing social events), behavioral changes and decision-making issues.
On mini memory assessment she is able to confirm the year, but showed poor short-term memory, inability to state the month, day and date on multiple attempts. I also had a discussion with them about difference between dementia and Alzheimer.
Please note that she has a family history of Alzheimer. Based on her symptoms my provisional diagnosis is Dementia possibly due to early stage Alzheimer. However, more assessment is required before definite diagnosis.
Your evaluation of the patient is appreciated. please feel free to contact me for any questions.
Yours Sincerely,
Doctor
Dr Jones
Newton Memory Clinic
400 Rail Road, Newton
19/04/2015
Dear Dr Jones, I am referring to you my patient Mrs. Patricia Welshman with signs of dementia for a full memory assessment. She is an 85 years widowed old woman, who lives alone at her house.
Today I saw her in my office accompanied by her daughter. They were concerned about memory issues my patient had developed for several months before. Lately, she started to forget her hairdressing, dinner engagements, social events. Her behavior and decision-making ability were also compromised.
She had a history of Alzheimer’s disease in her family. She had been treated for osteoporosis and hyperlipidemia with Vit. D and statins, but she didn’t take her medications regularly. On her last visit, her LDL level was 3.5, and her vitamin D level was 20. She didn’t have any other serious health issues.
On my brief examination, she was able to tell the date today only on several attempts. She was worried about having dementia. She has been explained the difference between dementia and Alzheimer’s disease.
I would be grateful if you could do a full memory assessment for my patient. For any additional information regarding my patient’s medical records, please do not hesitate to contact me.
Yours sincerely
Dr. Azat
Dr. Jones,
Newtown Memory Clinic
400 Rail Rd,
Newtown
19 April 2015
Dear Dr. Jones,
Re: Mrs. Patricia Welshman
DOB: 28/03/1930
Thank you for seeing, Mrs Welshman, a widower for 50 years who lives alone and is suffering from recent onset dementia. I request a comprehensive memory assessment for her further diagnosis and management.
Mrs Welshman, a known case of osteoporosis, presented to my clinic with her daughter today with complaints of poor memory, behavioral changes, difficulty in making decisions and forgetting people like her hairdresser recently. On mini memory assessment , she could not recollect the date despite several attempts, she confirmed the month on the third chance, but was able to confirm the year. Her family is concerned as she lives alone, although her children live close-by. There family history of Alzheimer’s disease and they suspect early onset Alzheimer’s. I have discussed in detail the possible causes of dementia including the Alzheimer’s.
She is taking medications for osteoporosis, hyper-tension and hyperlipidemia. She often forgets to take her medications and needs regular review. Her prescription consists of osteoVitD 1000IU, atorvastatin 20mg mane, ibuprofen 200mg prn, metoprolol 100mg bd and paracetamol 500mgprn. Her recent cholesterol is raised(3.5mmol/L) and vitamin D levels are below 20. Her BP is well controlled on medications.
I would be grateful if you could conduct a full memory assessment and help in further management of my patient. In case of any further information, please feel free to contact me.
Sincerely,
Doctor
Dr. Jones
Newton Memory Clinic
400 Rall Road
Newton
19/04/15
Dear Dr. Jones,
RE: Mrs. Patricia Welshman
DOB: 28/03/1930
Thank you for seeing Mrs. Patricia Welshman, an 85-year-old lady, for her symptoms of poor memory. It is request that you may provide a full memory assessment and diagnosis of her current symptoms.
Mrs. Welshman came in today for a routine review with her daughter, raising concerns about her recent lapse in memory. She has been missing her social appointments and having difficulty in making decision. Additionally, behavior changes have also been observed by her daughter. On examination of memory, Mrs. Welsh could not recall the day or date, however confirmed the month (on 3rd attempt) and the year ( on 1st attempt) correctly.
Mrs. Welsh has osteoporosis for which she takes Vitamin D, Ibuprofen, paracetamol. Additionally, she takes Atorvastatin and Metoprolol for her cholesterol and blood pressure, respectively. She had deranged lab values 3 months ago due to non compliance of medication, which have now improved.
She is a widow for 40 years and currently lives alone. She has family history of Alzheimer’s disease in her family and has been counselled for it being a cause of her symptoms.
I am suspecting early stage Alzheimer’s and humbly request you to perform a memory assessment for a definite diagnosis.
Please contact me for any queries.
Yours Sincerely,
Dr. Maryam Majeed
Dr Jones
Newton Memory Clinic
400 Rail Road
Newtown
25/10/2021
Dear Dr Jones,
Re: Mrs Patricia Welshman
DOB: 28/03/1930
Thank you for seeing my patient, Mrs Welshman, a 91-year-old widow who shows signs suggestive of dementia, probably the early stage of Alzheimer´s, for assessment and diagnosis.
On review the 19/04/2015, she presented accompanied by her concerned daughter with complaints about poor memory. She reported forgetting repeatedly social events. Furthermore, behavioural changes and decision-making issues were noted. On examination, a mini memory test revealed poor short-term memory. Due to her request, different kinds of dementia were discussed.
She has osteoporosis and hyperlipidemia. In the past, she had compliances issues, which resolved after she started using a webster pack. Her family history is positive for Alzheimer´s.
Given the above, I believe Mrs Welshaman requires a comprehensive memory evaluation. Your professional expertise would be greatly appreciated.
Yours sincerely,
Doctor
Dr.Jones
400 rail Rd Newton
Date:Nov 17 2021
Re: Mrs. Walshman
Thank you for accepting Mrs.Walshman, an 87-year-old widow for a full memory assessment.
Mrs.Walshman has been my patient for a long time. She has been compliant with her appointments till she develops a memory problem
Today Mrs. Walshman presented with her daughter with concerns about her memory issues. She has been missing her appointments and social events and has decreased decision-making capacity. She also forgot about her medications which are reflected from her pathology reports and was advised to start on a webster pack and she agreed. After starting, Her pathology reports came to normal range.
She also had a mining memory assessment at my office on which she correctly answer to the current year, month on 3 attempts and cannot remember the day, date on several attempts.
Mrs.Welshman also has dislipidemia, Hypertension, and osteoporosis for which takes Lipitor 20mg, Metoprolol 50, and Vitamin D.She also has a Family history of dementia.
Mrs.Walshman and her daughter were explained about early-stage Alzheimer disease and dementia as a symptom
I would highly appreciate if you can diagnose her based on your assessment.
Please contact me should you need further information.
Yours Sincerely
Doctor XYZ
Dr. Jones
Newtown Memory Clinic
400 Rail Road,Newtown
Dear Dr Jones,
Re:Mrs Patricia Walshman
D.O.B:28/03/1930
Many thanks for seeing Mrs Walshman.
I reviewed Mrs Walshman and her daughter in my clinic on 01/08/2018.They were concerned about Mrs Walshman’s memory issues such as forgetting hairdresser’s appointments, dinner engagements and missing social events.They also noted changes in her behaviour and issues with decision making.Her mini memory assessment showed poor short-term memory.They were quite worried as she failed to confirm day and date on several attempts, confirmed month on 3rd attempt and year on 1st attempt correctly.They requested further assessment of her condition as she has a family history of Alzheimer’s disease.They also enquired about dementia.I explained the difference between Alzheimer’s and dementia to them.
Mrs Walshman’s past medical history includes osteoporosis, hypercholesterolaemia and hypertension.Her current medications are osteo vit-D 1000 IU, Lipitor 20 mg mane, Bruten 200 mg pro, metoprolol 100 bd, Panadol 500 mg prn.
Mrs Walshman is a widow and lives alone.She has 5 adult children who live within 10 km radius.Her local council provides her home care once every fortnight.
Her BP and recent blood tests were within normal range.
She was assessed by occupational therapist about a year ago after a fall and appropriate recommendations were provided.
I would be really grateful if you could review her in your clinic and conduct a full memory assessment and establish a diagnosis.If you need further information please do not hesitate to contact me.
Yours sincerely,
Doctor
Dr Jones
Newton Memory Clinic
400 Rail rd, Newton
1/08/2018
Dear Dr Jones,
Re: Mrs Patricia Walshman
D.O.B 10/7/1933
I am writing to refer Mrs. Patricia, an 88-year-old widow, who has been having memory issues. I would be grateful if you could provide her with a full memory assessment and evaluation.
In April 2018, Mrs Walshman was noted to have elevated LDL level and decreased Vitamin D level. There were spare scripts of her medications but she assured me she has been compliant with her medications.
On today’s review, the pathology report was noted to have satisfactory results. However, Mrs Patricia and her daughter are both concerned with the patient’s memory issues. She has been forgetting appointments, dinner arrangements, missing social events, and has decision -making issues. She has family history of Alzheimer’s disease. Mini memory assessment was done which showed poor short -term memory.
In light of the above, I would be grateful if you could provide a definitive diagnosis of her memory issues. If you have further questions please contact me.
Yours respectfully,
Doctor
To,
Dr. Jones
Newton Memory Clinic
400 railroad
Newton
Re: Mrs. Washman , D.O.B: 10/7/1933
Dear Doctor Jones,
Thank you for seeing Mrs. Washman a 40 year widowed, Mother of five children and an Alzheimers patient for a complete memory assessment of her memory and a diagnosis.
She was diagnosed early-stage alzheimers She was visiting the general practioner regularly and was taking medications accordingly. Her past medical history showed a fall followed by an evaluation by an Occupational Therapist and has been advised for alternate day showers and home care.
on 26 march 2018 her blood test showed High LDL (2.9 mmol/l) and low calcium. The Patient was not compliant with the medical regime but was reluctant to accept a webster and promised to follow the medical regime.
on 1st August 2018, her vitamins and lipids were normal but her daughter complained of her gradual memory loss like forgetting hairdresser appointments, dinner Engagements, missing social events and the family was also worried about the behavioral changes and decision-making issues.
On examination, she showed poor short-term memory where she was not able to remember the day and date accurately after several attempts, guessed the month in 3 attempts, and confirmed the year accurately. She asked about Dementia and is also quite worried because she had a family history of Alzheimers but was explained the difference between them. So it would be very grateful if you see Mrs. Washman for further assessment before the specific diagnosis.
you can contact me anytime should you need any further information.
thanking you,
doctor
Dr Jones
Newton memory clinic,
400 Rail Rd,
Newton
1/8/2018
Dear Dr Jones,
Re: Mrs Patricia Walshman (DOB 10/7/1933)
Thank you for seeing Mrs Walshman, 80 year-old widow who is suffering from dementia, possibly due to early stage Alzheimers. I am referring to you for a full memory assessment and establishment of diagnosis.
She was brought by her today to my practice today to discuss memory issues. She was noted to have poor memory as she frequently forgets dates of events and appointments. Moreover, her daughter also noticed behavioral changes and decision making capacities. In addition, she has a family history of Alzheimer’s. On mini memory assessment, I noted poor short-term memory. She also demonstrated several failed attempts when it comes to day and date. She took three attempts to get the month correct, however, she answered the year correctly. She also appears worried.
On her previous visits, I noted spare scripts. However, she assured me that she has been taking her medications regularly. She was reluctant with the Webster pack that I have suggested, however she promised to adhere to her medication regime.
Based on the above, I believe she requires further evaluation and therefore, I would be grateful if you could further assess Mrs Walshman current problem and provide your management plan as you feel appropriate. I will be reviewing her after your assessment for further follow-ups. Do not hesitate to contact me in case of any queries.
Yours sincerely,
Doctor
Dr Jones
Newtown Memory Clinic
400 Rail rd,
Newton
July 18th 2010
Dear Doctor Jones,
RE.: Mrs Patricia Walshman
DOB: 10/07/1933
I am writing to refer to you, Mrs Patricia Welshman, who has memory problems for further assessment and management.
Today, Mrs Welshman came to my office because she reported a poor memory. She perceived that she forgets her daily activities like hairdressing, dinner engagements and missing social events. Mrs Patricia also exhibited behavioural changes about decision-making issues. On the mini memory assessment, she presented poor short term memory. She has a family history of Alzheimer’s disease.
Mrs Welshman has been diagnosed with osteoporosis. Her current medications are metoprolol, atorvastatin and Vit D. I noticed that she forgot to take her pills. Consequently, I recommended using Webster packs. She presented alterations in her lab test results in LDL and Vit D values. Today her lab values are unremarkable.
Kindly provide appropriate evaluation and management of Mrs Welshman’s condition.
If you have any queries, please feel free to contact me.
Sincerely yours.
03 March 2022
Dr Jones
Newtown Memory Clinic
400 Rail Road
Newtown
Dear Dr Jones,
Re: Mrs Patricicia Walshman, DOB: 10/07/1933
I am writing regarding Mrs Patricia Walshman, who has dementia possibly due to Alzheimer’s disease. He is being referred for full memory assessment to confirm her diagnosis.
Mrs Walshman presented today with her daughter with notable changes in her behaviour and decision making. She forgets
03 March 2022
Dr Jones
Newtown Memory Clinic
400 Rail Rd
Newtown
Dear Dr Jones,
Re: Mrs Patricia Walshman, DOB: 10/07/1933
I am writing regarding Mrs Patricia Walshman, who has dementia possibly due to Alzheimer’s disease. She is being referred for full memory assessment and to confirm her diagnosis.
Mrs Walshman presented today with her daughter with notable changes in her memory, behavior and decision making. Mini memory assessment conducted and poor short-term memory found. Her blood pressure and blood reports were normal.
On previous visit in March 2018, Mrs Walshman had deranged lipid function tests and vitamin D level. She had spare prescription slips and medication, likely due to not taking medicines regularly. She became compliant with the use of Webster packs, and her lab reports come to normal.
Mr Walshman has strong family history of Alzheimer disease. She takes osteo vitamin D 1000, atorvastatin 20mg mane and metoprolol 100mg twice a day.
Looking above, it would be beneficial for Mrs Walshman if your could assess for full memory assessment to confirm whether she has Alzheimer’s disease or any other type of dementia. I had discussed with her daughter regarding this.
If requires any further information, please do not hesitate to contact with me.
Yours sincerely,
Doctor
Dr Jones
Newton memory clinic
400 Rail road
Newton
01/08/2018
Dear Dr. Jones
Re: Mrs Patricia Walshman, D.O.B: 10/07/1933
I am writing to refer Mrs Walshman, an 89-year-old widow who has features suggestive of dementia and possible early stage Alzheimers, for a full memory assessment.
Today, Mrs Walshman presented with complaints of frequent memory loss, behavioural changes and inability to make decisions. She mentioned forgetting about appointments and social events, which was confirmed by her daughter. Upon a mini-memory assessment, she exhibited short-term memory loss and was able to recall the year and the month but not the day and date. She was explained the difference between Alzheimers and dementia upon her request.
Regarding her medical history, she had a fall in 2017 and received an occupational therapist home assessment following that. Her full blood panel results conducted in March 2018 were normal. Her regular medication include atorvastatin, ibuprofen, metoprolol, paracetamol and vitamin D tablets for osteoporosis. Socially, she lives alone with her children residing within a 10 km radius. Her family history is positive for Alzheimers disease.
In light of the above, kindly provide full memory assessment and definitive diagnosis for Mrs Walshman’s condition. If you have any queries, please do not hesitate to contact me.
Yours sincerely,
Doctor.
Dr Jones
Newton Memory Clinic
400 Rail rd
Newton
12 April 2022
Dear Dr Jones
Re: Mrs Patricia Walshman DOB: 10/07/1933
Thank you for seeing Mrs Walshman, a 85-year-old widow who has dementia and requires your assistance in full memory assessment and diagnosis of her condition.
Mrs Walshman first started having these issues 4 months ago when she not taking her medications regularly and forgetting to fill spare scripts. Her BP was 145/85 at that time. I suggested Webster pack back then. But she was reluctant and promised me to take her medications regularly. Her medications were Vitamin D supplements for osteoporosis, lipitor 20mg and metoprolol 100mg b.d.
On 1/08/2019, Mrs Walshman again presented to the GP surgery with her daughter. Her BP was stable and her medication issue was resolved but they both were concerned about memory issues. It was found that she was forgetting multiple stuff like her hairdresser appointments, dinner engagements and missing social events. Behavioral changes were also noted and she was also having issues in decision making.
Please note that, Mrs Walshman has family history of Alzheimer’s disease. A mini memory assessment was conducted that revealed the poor short-term memory. She was able to tell the year and month but couldn’t tell the date and time. She also correctly explained the difference between dementia and Alzheimer’s disease.
Mrs Walshman was quite worried about that so she requested further assessment. Please note that she lives alone but has the facility of home care that is only provided once a fortnight.
It would be highly appreciated if you could do full memory assessment and diagnose her condition.
Yours sincerely
Doctor
13th April 2022
Dr. Jones
Newtown Memory Clinic
400 Rail Road
Newtown
Dear Dr. Jones,
Re: Mrs. Patricia Weisman
DOB: 28/03/1930
I am writing to refer Mrs. Weisman, for a complete memory assessment.
Mrs. Weisman, who is widowed and lives by herself , was recently brought by her daughter complaining of difficulties remembering her her social appointments. She has also developed behavioural changes and difficulty making decisions.
A mini-memory assessment was done and she was found to have poor short term memory. She was able to confirm the year correctly. However, she was unable to get the day and date right but said the correct month after three attempts. Mrs. Weisman was concerned as she has a family history of Alzheimer’s disease and requested a complete assessment. I suspected Mrs. Weisman to be having dementia and explained the difference between dementia and Alzheimer’s disease.
Mrs. Weisman has osteoporosis and elevated cholesterol for which she is taking the relevant medication. She is otherwise healthy. Home care is provided once a fortnight.
Kindly, perform a full memory assessment and provide your diagnosis.
Yours Sincerely,
Doctor
Ms Bhavna Sandrine
Charge Nurse
Palmer Home Care Facility
Baltimore
03/01/2018
Re: Mrs Caderina Piper, aged 90
Dear Ms Sandrine,
Thank you for accepting Mrs Caderina Piper into your care, she requires your ongoing medical and psychological support for her generalized condition. Please note that she has been diagnosed with pernicious anemia, osteoarthritis, and urinary incontinence.
Mrs Piper has been taking treatment for post-traumatic stress disorder as a result of she was undergone an unlikely robbery attempt that happened in October 2016. However, after six months she was presented with a depressed and crying because she want to move to her new home.
Mrs Piper has been seen with severe paranoia symptoms after her nine-month stay in a new facility. She was hospitalized in a psychiatric ward perhaps she well recovered without antipsychotic medication. Currently, she is well active and fully independent in her errands.
It would be greatly appreciated if you could give psychological support and kindly provide counseling to explore her feeling. Kindly give Haloperidol tablet 1.0mg every day once only.
Please do not hesitate to contact me for any questions.
Yours faithfully
charge nurse.
Dr Jones
Memory Clinic
400 Rail Rd
Newton
Dear Dr Jones,
Re : Mrs Patricia Walshman (D.O.B : 10/07/1933)
I am writing to refer Mrs Walshman an 85 year old lady with suspected early stage of Alzheimers disease.
This is my patient since 2010. Mrs Walshman came with her daughter and were concerned about memory issues. Poor memory was noted for instance forgetting special occasions.Mrs Walshman was also noted to have behavioural changes and decision making problems.
On mini memory assessment , she had poor short term memory as day and date after several attempts there was no results.She was able to know the month after 3 attempts and confirmed the year correctly.Mrs Walshman has a significiant family history of Alzheimers disease.
I kindly request full memory assesment and diagnosis.
Any queries, please do not hesitate to contact me
Yours sincerely,
GP surgery
Dr. Jones
Newtown Memory Clinic
400 Rail Rd
Newtown
01 August 2018
Re: Mrs. Patricia Walshman (DOB: 10/07/1933)
Mrs. Patricia Walshman is regular patient of clinic and known case of osteoporosis and dementia, and living alone at home. Moreover, family history of Alzheimer’s. Currently, she is taking taking Osteo Vit 1000 IU, atorvastatin 20 mg/OD, ibuprofen 200 mg/prn, metoprolol 100 mg/BD, Paracetamol 500 mg/prn. Currently provided with home care once fortnightly.
On 28-March-2018 routine test were performed, LDL cholesterol was high and Vit-D was low rest were OK. Furthermore, she is not taking medicines regularly, suggested webster pack and assured she will take medicines timely. 01-August-2018 all tests were normal. Meanwhile, considering patient situation mini memory was performed. Assessment suggests, poor short term memory and patient attempted several times to mention date, time, month, but year confirmed quickly. Patient requested for further assessment
I am referring Mrs. Patricia Walshman to your memory to provide brief assessment and full memory assessment for diagnosis and treatment.
If you have any further questions, please do not hesitate to contact me
Yours Sincerely,
Dr. Abdul Basit
Newtown memory clinic
400 Rail rd
Newtown
01/08/2018
Dear Dr Jones,
Re: Mrs. Patricia Walshman
DOB: 10/07/1933
Thank you for seeing Mrs. Walshman for recently memory problems which require your further assessment and management.
Mrs. Walshman is my long-term patient, regularly visiting my practice. Past medical history is remarkable for a fall which occurred in 2017. successfully managed with occupational therapy. In one on the previous assessment, low level of vitamin D along with high level of LDL cholesterol has been found. Osteo vit-D 1000 UI along with Atorvastatin 20 mg daily was prescribed for this purpose. Mrs. Walshman is not compliant with regularly taking the prescribed medication and Webster pack was suggested as a temporary solution.
Today, she attended to clinic accompanied with her daughter, and both expressed concern about recently problems with memory, developed during the last few months. According to them, she started frequently to forget about the daily obligations like social events engagement accompanied with some behavioral changes and decision-making problems. On the assessment, poor short-term memory problems were noticed. She has a positive family history about Alzheimer disease.
I would like to kindly ask you to see Mrs. Walshman for the further management and assessment regarding memory symptoms which recently developed and possibly developing of early Alzheimer disease.
Should there be any queries, please do not hesitate to contact me.
Yours sincerely.
Dr S Stojkovic
Dr. Jones
Newtown Memory Clinic
400 Rail rd
Newtown
August 1,2019
Dear Dr.Jones.
RE: Mrs Patricia Walshman D.O.BB: 10/07/1933
I am writing to refer Mrs Walshman, a widowed patient,who has been complaining of acute memory deterioration,for further evaluation of her mental state and clinical management.
Mrs Walshman,lives along ,she has a previous medical hystory of osteoporosis , high cholesterol and blood pressure also chronic pain,for which she takes osteo-Vit D,lipitor ,metoprolol , panadol and i also buprofen.
In Octuber 2017,she fell down at home with mínimal injury.Consequently , a further assessment with the occupacional therapist was suggested to help Mrs Walseman’s with her daily activities ,provided home support at night and also bedrail protection to avoid further falls.
In March 2018, Mrs Walshman started to skipping her medication,according with her daughter,for which ,a Webster pack with a weekly calendary was suggested.Her cholesterol panel done returned within normal limits.
On today’s visit,Mrs Washeman ,comes accompanied with her daughter,who is concerned about acute memory decline of her mother;who has been presenting with acute memory loss,along with behavior changes,forgetfull dates and events, as well as social isolation.On the minimental test, she failed to remember objets,but only confirmed the year. I told to her daughter about the difence between Alzheimer’s disease and dementia,but Mrs Walsheman requires special memory support and assessment.
I would appreciate your further evaluation and management.if you have any queries ,do not hesitase to contact me.
Yours sincere,
Doctor
16/09/2022
Dr Jones
Newtown Memory Clinic
400 Rail road, Newtown
Dear Dr Jones,
RE: Mrs Patricia Walshman D.O.B 10 July 1933( 89years)
Thank you for seeing Mrs Walshman, an 89 year old whom I have seen with her daughter Christine. She has presented with symptoms suggestive of cognitive impairment therefore needs further evaluation and diagnosis.
They report a history of forgetfulness for example hairdresser appointments, social engagements like dinners and also behavioural changes like with decision making. She previously had difficulties with her medications that were resolved with use of a webster pack.
On MMSE today, she demonstrated poor short term memory with registration as was unable to state the day, date or months after 3 attempts.
There is a family history of Alzheimer’s dementia. Mrs Walshman is prone to falls and currently has community support once every fortnight. She also has osteoporosis and hypertension for which she takes ,osteo Vit – D1000IU,atorvastatin (lipitor) 20mg in the morning, metoprolol 100mg twice daily, ibuprofen (Bruten) 200mg and paracetamol ( panadol 500mg) whenever needed.
They enquired about dementia and I explained to them the difference between Alzheimer’s and dementia and the need to have further assessments by the memory clinic and it is for this reason that I am referring her to your specialist services.
Incase of any queries do not hesitate to contact me.
Yours Sincerely,
Doctor.
(Barnett)
1 August 2018
Dr Jones,
Newtown Memory Clinic,
400 Rail rd,
Newtown.
Dear Dr Jones
Re: Mrs. Patricia Walshman
DOB: 10/07/1933
I’m writing to you regarding Mrs. Walshman, 85-year-old women known for osteoporosis and dementia, who has been recently facing difficulty remembering. I’m suspecting Alzheimer disease considering the positive family history.
Mrs. Walshman’s mini memory assessment today showed poor short-term memory. She has been missing social events, changed her behavior and had issues with decision making abilities.
She is widow and live alone. She has regular visits to this clinic. She recently had a fall resulted in some bruises but no fracture. As a result, she had OT home assessment and modification of lifestyle routines.
Mrs. Walshman latest labs, on 26 of Marsh 2018 showed normal CBC, LFT and lipid profile (except LDL slightly high 2.9). on the other hand, she has Vitamin D deficiency (<54). She is on Vit-D 100 IU, atorvastatin 20 mg mane, ibuprofen 200 mg prn, metoprolol 100 mg b.d, and paracetamol 500 mg prin. However, she showed difficulty adhering to her medications.
Thank you for seeing Mrs. Walshman for further memory assessment
Please do not hesitate to contact me for any detail.
Yours sincerely,
Doctor
1 August 2018
Dr Jones,
Newtown Memory Clinic,
400 Rail rd,
Newtown.
Dear Dr Jones
Re: Mrs. Patricia Walshman
DOB: 10/07/1933
I’m writing to you regarding Mrs. Walshman, 85-year-old women known for osteoporosis and dementia, who has been recently facing difficulty remembering. I’m suspecting Alzheimer disease considering the positive family history.
Mrs. Walshman’s mini memory assessment today showed poor short-term memory. She has been missing social events, changed her behavior and had issues with decision making abilities.
She is widow and live alone. She has regular visits to this clinic. She recently had a fall resulted in some bruises but no fracture. As a result, she had OT home assessment and modification of lifestyle routines.
Mrs. Walshman latest labs, on 26 of Marsh 2018 showed normal CBC, LFT and lipid profile (except LDL slightly high 2.9). on the other hand, she has Vitamin D deficiency (<54). She is on Vit-D 100 IU, atorvastatin 20 mg mane, ibuprofen 200 mg prn, metoprolol 100 mg b.d, and paracetamol 500 mg prin. However, she showed difficulty adhering to her medications.
Thank you for seeing Mrs. Walshman for further memory assessment
Please do not hesitate to contact me for any detail.
Yours sincerely,
Doctor
Dr Jones,
Newtown memory clinic,
400 Rail rd,
Newtown.
22 September 2022
Dear Dr Jones,
Re: Mrs Patricia Walshman
DOB: 10/07/1933
Thank you for seeing Mrs Walshman, a 40 year old long term patient with dyslipidaemia and hypertension who has presented with reduced memory and referred to you for memory assessment and diagnosis.
On 01 August 2018, Mrs Walshman has first complained of memory impairment. Her daughter confirmed that as Mrs Walshman has missed many personal events due to this and also associated with alteration of behavior and issues in decision making. They also have a confusion on Dementia and Alzeimer’s disease. Examination was unremarkable except poor short term memory noted in mini memory assessment. Though she correctly mentioned the year, she had to attempt thrice to say the month and could not tell the date even after multiple attempts.
In addition, she had a history of poor compliance to medication from March 2018 even though she was committed on adherence to medication. On examination BP was 145/85 mmhg . Apart from LDL cholesterol being 2.9 mmol/L and vitamin D being less than 54 mmol/L , other investigations were unremarkable.
She was on Osteo Vit-D, 20mg of atorvastatin mane, 100mg of metoprolol twice a day and other painkillers.
She has a family history of Alzheimer’s disease. She also has a history of fall on 01 October 2017 with unremarkable x-ray.
She is a widowed, but having five adult children. Though she lives alone, all her children are living within 10km radius.
Hence, I would be grateful if you could kindly see Mrs. Walshman who is suspected to be having Dementia or early onset Alzheimer’s disease and proceed with full memory assessment to diagnose her disease condition. Should you have any queries please do not hesitate to contact me.
Thank you.
Yours sincerely,
Doctor.
Dr Jones
Newtown memory clinic
400 Rail road
Newtown
1 August 2018
Dear Dr Jones,
Re: Mrs Patricia Walshman, DOB 10.07.1933
I would like to refer Mrs Walshman to you for a full memory assessment and to provide her with a definitive diagnosis. i am suspecting that she has early stage Alzehimer’s disease and osteoprosis.
Mrs Walshman and her daughter are concerned about her memory, as a poor memory was notice in forgetting important appointments, behavioral changes and decision making issue. Her mini memory assessment shows poor short term memory. She requested further assessment. She has family history of Alzheimer’s disease and dementia.
She has a history of fall 2017 for which she had an occupational health assessment , house modification and community support.
she has problem in remembering taking her medication which was solved by Webster bag.
Her current medication is osteo vit-D 1000 IU, atorvastatin 20mg at bed time, ibuprofen 200mg as needed, metoprolol twice daily and paracetamol 500 mg as needed.
I will be grateful for your assessment to her and providing her with definitive diagnosis.
If you have any questions please do not hesitate to contact me.
Yours sincerely,
Doctor
Dr Jones
Newtown Memory Clinic
400 Rail, rd
Newtown
01/08/2018
Dear Dr Jones
Re: Mrs Patricia Walshman, DOB 10/07/1933
I am writing to request a full memory assessment for Mrs Walshman, an 89-year-old widow who presented with concerns regarding her memory.
Mrs Walshman attended my surgery today for a regular check-up with her daughter who noticed that her mother has had a poor memory, missed her social appointments, lost medications and behaved awkwardly for instances. Additionally, decision-making issues were observed. A mini-memory assessment was conducted and revealed poor short-term memory.
Mrs Walshman has concerns about having dementia or Alzheimer’s disease. Therefore, a discussion to differentiate between them was conducted. Therefore, it would be greatly appreciated if you could provide Mrs Welshman with a definitive diagnosis.
Mrs Walshman has osteoporosis and a significant family history of Alzheimer’s disease. Please note, she lives alone and had a fall at home for which an occupational therapist visited her home to assess the suitability of Mrs Walshman’s capabilities and to apply modifications that could lessen the likelihood of repeated falls. For the same reason, community support by a local council was also provided.
Her regular medication list is attached for your reference. If you have any queries, please do not hesitate to contact me.
Yours sincerely,
Doctor.
Dr. Jones
Newtown memory clinic
400 Rail rd, Newtown
1st August 2018
Dear Dr. Jones
Thank you for seeing my long-term patient, Mrs. Patricia Walshman, born in 1933, widowed with five adult children. I’m concerned about her memory.
Mrs. Walshman is a kniwn case of osteoporosis and dementia, she is on vitamin D 1000 IU, atorvastatin, ibuprofen, metoprolol and paracetamol.
On her visit on 26th of march 2018, her checkups showed that her BP was 145/85, LDL cholestrol was 2.9 mmol/l and her vitamin D was below 54 mmol/l. It was because shw wasn’t taking her medications reglarly so I suggested Webster pack, she was reluctant and promised to take her medications regularly.
Now her BP, vitamins and lipids are within the normal range, but now Mrs. Walshamn and her daughter want to discuss her memory issues as she started to forget appointments, missing social events, she is developing behavioral changes and decision making issues. On assessment, she has poor short-term memory, she is wooried as she has family history of alzheimer’s. She needs futher assessment.
I would be grateful if you could see her in your clinic for full memory assessment before confirmming the diagnosis.
Yours sincerely
Dr Jones
Newtown Memory Clinic
400 Rail, rd
Newtown
RE: Mrs. Patricia Walhsman
DOB: 10/07/1933
Dear Dr. Jones,
Thank you for seeing Mrs. Walhsman, a 89 year old patient, who requires memory assessment and correct diagnosis of dementia. She is a regular patient in my office. She lives alone, widowed for 40 years now and surrounded by her children and grand-children. She started the issues with the memory after a fail in her house in 2017, which it was assessed by an Occupational Therapist. In 2018, blood test revealed deficiency of vitamine D and high levels of LDL, although she had prescribed atorvastatin and oste-vit D. Probably, she forgot take her medications. A recent visit to her, she came with one of her daughter and the results of the test were much better, with normal levels of lipids and vitamine D. The daughter showed huge concern about the forgettings. Such as, Mrs. Walhsman forgot her dates with hairdresser or forgot social dinners, for example. Moreover, her daughter noticed behavioral changes.
For all these reasons, I request you further assesment to rule out a dementia or Alzheimer`s Disease.
Do not hesitatet to contact me in case of any doubt.
Yours faithfully,
Doctor.
Dr.Jones
Newtown memory clinic
400 rail rd
Newtown
Date : 1/08/2018
Dear Dr .Jones
Re :Mrs .Patricia Walchman
D.O.B ; 10/07/1933
Iam writing to refer Mrs Patricia .an 85 year old widowed into your care who requires full memory assessment to confirm the preliminary diagnosis of dementia with potential early stage Alzheimers.
Mrs Patricia lives alone ,has 5 adult children ,she has been on regular GP visits from 2010-2016 ,taking vit D ,ibuprofen and paracetamol for her osteoperosis ,atorvastatin , and metoprolol for her dyslipedemia and hypertension respectively ,the onset of her current concern started on 1st/october/2017 when she fell down and got bruised nose only ,in the following month was arranged for occupational therapist home assessment ,of which discussed shower issue with advice given to lessen the likelihood of fall.
the patient has been reviewed 6 months latter,and have had her blood biochemestry checked that revealed all within normal except slightly elevated LDL cholestrol and low vit d level that attributed to patient wasnt taking her medication regularily therefore suggested Webstare pack but patient promised to adher to regular medication intake .
today patient attended with her daughter to review her follow up her investigations which is showing an improvment and indicated that medication problem has resoloved,however both concerned of patient memory deterioration , reported forgetting of important daily activity functions and impaired ability of making decision,on primary assessment pt showed memory impairement that needs further evaluation to confirm the diagnosis of dementia with potential Alzeheimers disease.
would be gratfull if you could review Mrs patricia and provide her with further investigations and final diagnosis,should you have any further quiries ,please dont hesitate to contact me.
Dr Jones,
Newtown Memory Clinic,
400 Rail Road,
Newtown
01/08/2018
Dear Dr Jones
Re : Mrs Patricia Walshman, D.O.B : 10/07/1993
Thank you for seeing Mrs Walshman who is being managed for Osteoporosis , Dementia to rule out Early Stage of Alzheimer. I am referring her to you for full memory assessment and diagnosis.
Mrs Walshman presented to my clinic with her daughter with concern of Mrs Walshman ‘ memory. She was noticed to spare scripts while filling them and miss her medications . She was equally noticed to be forgetting her appointments such as hairdresser, dinner and social events with associated behavioural and decision making issues.
My mini memory assessment, revealed that she has poor short-term memory with day, date and month but not with year and she appeared worried.
Mrs Walshman evaluation on the March 26, 2018 revealed elevated BP ( 145/8), with laboratory derangement in lipid profile ( LDL 2.9mmol/l, LDL/HDL 2:1) , vitamine D low, others appeared normal.
On her review in August, she appeared to have good values in her lipid level with good BP control and good drug complaince.
Mrs Walshman is a widow with 5 children, with family history of Alzheimer, she currently has community support by local council. And currently on her medications for osteoporosis and blood pressure.
in the light of the above , I am referrring Mrs Walshman to you for full memory assessment and diagnosis.
If there is any query do not hesitate to contact me.
Yours sincerely
Dr O. C.F
GP surgery
Dr Jones
Newtown memory clinic
400 Rail road, Newtown
01/August/2018
Dear Dr,
Re: Mrs. Patricia Walsman, DOB: 10/07/1933
I am writing to refer Mrs. Walsman, a long-term patient of mine who presented with progressive memory issues. Your further memory assessment and diagnosis of her is highly appreciated.
Mrs. Walsman is a widow for 40 years who lives alone. She is taking osteo Vit-D, atorvastatin, metoprolol regularly and ibuprofen and paracetamol as needed.
On 1st October 2017, she got nasal bruise from fall injury but her X-ray was normal. Subsequently, her home was assessed by an Occupational therapist for shower rails, ramps and bed which were found to be normal. She was provided with home care by local council once every fortnight.
Her all examination findings and lab reports were normal except LDL cholesterol and Vitamin D level on 26 March 2018. And she was advised to take her medicines regularly as she was not compliance with her medication regime.
On today’s visit, her all lab results and examination findings are normal. Even medication issues were resolved. However, she and her daughter wants to discuss regarding her ongoing memory problems as they noted changes in her behavior, missing social events, decision making ability, and forgetting appointments. On mini memory assessment, she has poor short-term memory on day and dates. She is quite worried about it and request for further evaluation. Please note, she has family history of Alzheimer’s disease.
In light of her current situation, I am referring her for further full memory assessment and diagnosis. If you need any further information, please feel free to contact me.
Yours sincerely,
Doctor
Dr. Jones,
Newtown Memory Clinic
400 Rail rd,
Newtown
2/08/2018
Re: Mrs. Patricia Walshman
D.O.B.: 10/07/1933
Dear Dr. Jones,
I am referring you, Mrs. Walshman, an 80-year-old woman, who suffers from dementia vs Alzheimer’s disease and I would like to give her further assessment and diagnosis.
Mrs. Walshman is widowed and she has 5 adult children, whose Cristine is the daughter most kin to her. She suffers from osteoporosis and she has been stable until October 2017, when she felt and she began to slow down. On November 2017, an Occupational Therapist evaluated her home and modified some home furniture, like the shower. She has also community support.
In March of this year, her blood test revealed that she didn’t take her medication with low vitamin D and high cholesterol. In August, we arranged an appointment with better results in the blood test but her daughter wanted to discuss memory issues. For instance, Mrs. Walshman forgets hairdresser appointments or dinner engagements. She also observed some behavioral changes or decision-making issues in Mrs. Walshman. The mini memory assessment revealed poor short-term memory with several temps for day and month but not for a year. She has also a family history of Alzheimer’s.
With all these symptoms I am referring you the patient to give her a full memory assessment and final diagnosis.
Do not hesitate to contact me in case of any doubt.
Yours sincerely,
Dr.
Dr Jones
Newton Memory Clinic
400 Rail road
Newton
4/4/23
Re: Mrs Patricia Walshman ( DOB: 10/7/1933)
Respected Sir,
Thank you for agreeing to see the patient. Mrs Walshman is suspected to have dementia likely due to early onset Alzheimer’s disease for which she requires a full memory assessment for a definitive diagnosis.
Mrs. Walshman was brought in by her daughter with chief complaints of memory loss. According to the informant, patient was noted to have poor memory along with behavioral issues and decline in decision making capacity. I performed a mini mental assessment where patient was found to have a poor short term memory. She was unable to recall the day and time despite several attempts. However, she was able to recall the month in 3 attempts and confirmed the year correctly at one go. As Mrs Walshman and her daughter were quite concerned about the results, I explained to them the possible diagnosis of dementia likely due to early onset Alzheimer’s disease and further explained to them the nature of it. Patient and her daughter were also counseled regarding the need for neurological assessment for a definitive diagnosis.
Mrs Walshman is a widow who lives alone with a history of recurrent falls. She receives home care provided by local council along with occupational therapist assessment. She further has a history of being non-compliant to medication for which she was started on Webster pack. The issue has since being resolved. She is currently being managed for osteoporosis, hyperlipidemia and hypertension for which she takes Osteoi Vit D 1000iu along with an NSAID and PCM , Atorvastatin 20g mane and Metoprolol 100mg BD respectively.
Given the above, I would be grateful if you could kindly provide me your expert opinion regarding her neurological status with a definitive diagnosis for further management and treatment. Please feel free to contact me should you require additional information.
Yours sincerely,
Dr Aishath M
Dr jones
newtown memory clinic
400 rail road
newtown
Dear dr.jones
07/04/2023
re:mrs walshmann
dob:12/07/1933
Thank you for seeing mrs Walshmann ,a 100 yr old lady diagnosed with dementia and possible alzeimers .she requires full memory assesment and confirmation of diagnosis
mrs walshmann has a past medical history of dimentia, osteoporosis ,hypertension, dyslipidemia for which she was prescribed on regular medications
she is failing to be compliant with these medications due to her memory issues for which she was counselled and sent home
5 months later she presented to clinic with resolution of medication issue and normal lipid ,b.p,vit d levels. However she was concerned with her poor memory which is causing her issues with decision making and behavior
A mini memory examination was performed where poor short memory was noticed as she was unable to remember day and date and struggled to say the month but clear with the year
she also had family history of alzemiers, i have explained her about difference between alzeimers and dimentia
i request you to do full memory assesement and confirm the diagnosis
should you have any queries ,do not hesitate to contact me
yours sincerly
doctor
Dr Jones
Newtown memory clinic
400 Rail rd
Newtown
1st August 2018
Dear Dr Jones,
RE: Mrs Patricia Walshman
DOB: 10/07/1933
I am writing you in order to refer Mrs Walshman to your Memory Clinic, a patient of mine who has recently developed a lack of short-term memory and decision making issues.
As for her social background, she has been widowed for 45 years. She lives alone at the moment, but her 5 children live nearby. She has a family history of Alzheimer’s disease.
She takes medication for hypercholesterolemia (atorvastatin 20 mg once per day), hypertension (metoprolol 100 mg twice per day) and osteoporosis (vitamin D 1000 UI monthly).
After she had fallen in her apartment in 2017, she was evaluated by an occupational therapist, who made her do showers every other day to lessen the likelihood of fall. She has also received community support since that time. A home carer visits her every 15 days.
She has not been always compliant to her therapy in the last few months, I suppose she forgot to take all her medications everyday. Though, her last blood exams were normal and her blood pressure seems well-controlled now.
During my last check, she and her daughter were worried about Mrs Walshman’s memory, because she starts forgetting everyday life activity planning (e.g. hairdresser appointments), she is struggling with decision making and her behavior is changing.
She did not score well at the Mini Memory Assessment, that is why I request you further investigations to make a differential diagnosis between dementia and Alzheimer’s disease.
I am available at any time for further details.
Yours sincerely,
Doctor
Dear Dr. Jones,
Hello, Dr. Jones.I am Dr. Sam Chou. Recently, one of my long-term patients, Mrs. Walshman, has been concerned about her memory. I would really appreciate it if you could help with her full memory assessment and your opinions on her diagnosis.
She is a ninety-year old woman who have been diagnosed with suspicious early stage of Alzheimers Disease. She also has family history of Alzheimers Disease. She has been suffered from forgetting some appointments and engagements in daily life. According to her and her daughter, she also has issues about decision-making and changes in her behaviors.
She has been widowed for over 20 year. She has been diagnosed with osteoporosis and taking therapeutic and symptomatic medication. She has borderline high blood pressure and high LDL under control of medical treatment.
We’ve done mini memory assessment for her and it has showed that her short term memory especially regarding day or date is getting worse. We’ve explained the difference between dementia and Alzheimers Disease. We really hope that you could consider giving her an appointment for full memory assessment. Please contact me if you have any questions about her condition. Thanks a lot.
Best Regards
Sam
16 May 2023
Dr Jones
Newtown Memory Clinic
400 Rail Rd, Newton
Re: Mrs Patricia Walshman, D.O.B.: 10/07/1993
Dear Dr Jones
I am writing to refer Mrs Patricia Walshman with dementia or possible early Alzheimer’s disease for further evaluation and confirmation of her diagnosis.
Mrs Walshman was brought by her daughter on 1/08/2018 with concerns regarding her memory. She seems to be forgetting things such as hairdresser appointment, dinner engagements and social gatherings. She also has behavioural changes and difficulty in decision making. She was not taking her medications regularly, which was solved after using a Webster pack. In mini memory assessment she could not say the day and date despite several attempts but confirmed the month and year, suggesting a poor short-term memory. She also has family history of Alzheimer’s disease.
Mrs. Walshman has osteoporosis for which she is taking Vitamin D, and prn analgesics (paracetamol and ibuprofen). She is also taking atorvastatin for hyperlipidemia.
I would highly appreciate if you could perform a full memory assessment to confirm her diagnosis.
If you have any queries, do not hesitate to contact me.
Yours sincerely
Doctor