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Case 13: Impairments in Registration and Working Memory (MCI Index = 6)
Case 13 is an 88-year-old twice-widowed woman with 11 years of education. Her medical history is of note for atrial fibrillation, a myocardial infarct, type II diabetes, a bowel resection for cancer and a recent head injury from a fall. Consultation was requested to determine her testamentary capacity, contractual capacity and vulnerability to undue influence. More extensive testing with the Wechsler Logical Memory Paragraphs confirmed severe-profound impairments in registration and working memory. The pattern and severity of her cognitive deficits made it impossible for her to gather sufficient information to enable her to make reasoned financial decisions regarding her property. The Court appointed a neutral fiduciary to manage her estate.
Orientation:
A score of 10 out of 12 falls within the low end of the average range and raises the question of either mild confusion or mild memory impairment. This patient should be followed with serial evaluations.
Attention:
A score of 8 out of 8 falls within the average range.
Language:
These Language scores fall within the average range.
Constructions:
A score of 2 out of 6 indicates significant spatial construction disability that needs to be further evaluated both medically and cognitively. Although spatial-construction ability varies widely in the normal population this score indicates moderate to severe spatial-construction disability.
Memory:
A score of 5 out of 12 indicates significant memory impairment. It is important to rule out treatable causes of memory problems and/or more general cognitive decline. This patient needs to be further evaluated both medically and cognitively.
Summary:
This patient has specific areas of impairment: Repetitions, Constructions, Memory, Calculations.
MCI Index:
The MCI Index of 6 strongly suggests a Mixed Dementia Syndrome that is likely to impact occupational and social functioning. This patient should be further evaluated for treatable causes of cognitive decline.
