Jackie Smith is an 82-year-old right-handed Caucasian woman. She has been diagnosed with dementia and her eldest son has petitioned the court for guardianship in the past. At that time Mrs. Smith's eldest son and his family were living with her. A psychiatrist following her case at the request of her son diagnosed Mrs. Smith with dementia based on interviews with her eldest son, his wife, and an interview with the patient's 16-year-old granddaughter who suggested that the patient was forgetful to the point of being a danger to herself. This led the physician to conclude the patient suffers from a progressive dementia and that the patient needed assistance in her self-care. He also recommended that the patient not drive and informed the Secretary of State regarding his findings. However, the patient's primary care physician asked for a second opinion as Mrs. Smith's son and family had approached him previously and was apparently was attempting to gain control of the patient's property and assets. The patient's son and his wife are unemployed and moved in the patient's home one day while she was out with friends. The patient reported that this initially helped her feel less anxious and depressed, but then they took over control of the patient's affairs. The patient reports that they were stealing money from her and trying to make her crazy by hiding things from her. They would not let her pay her bills and would not let her take her own medications, which she had been doing successfully with a medication organizer and reminders prior to their moving in.
The patient's medical history is significant for CVA in 2004 (although from her description of the symptoms and duration it sounds more like a TIA), coronary artery disease, hypertension, arthritis, depression, and anxiety. With respect to her CVA, the patient reports that it occurred at a casino and that she became very confused for a short period...
Neuroimaging performed at St. Bingo's Hospital reportedly revealed some stroke related changes in her left cerebral hemisphere according to her son, but I was unable to read this report. The patient reports another brief period of confusion occurring in November of 2007 that was also transient. She has no seizure history. Her medications at the time of this report included Memantine, Etodolac, Fluoxetine, Simvastatin, Alprazolam, Buspirone, Tramadol, Plavix, Lisinopril, and Isosorbide. She does not smoke, drinks alcohol socially, and does not use illicit drugs.
Recently the patient suffered an episode of confusion and agitation and was hospitalized. She did not recognize her family members, thought that she was in France, and reported to hospital staff that she was having conversations with her deceased husband. Inspection of her laboratory values indicated that all results were within normal limits. The neuropsychologist at the hospital recommended that the patient discontinue the Seroquel that the psychiatrist who diagnosed her with dementia had prescribed and was being given to her by her son. Three days after the discontinuation of the medication her mental status stabilized and she was released, although the social worker at the hospital was suspicious of the patient's caregivers and made an appointment for Family Protective Services to follow the patient.
The patient became very aggressive towards her older son once she returned home and demanded that she be able to monitor her own medications. Her son refused and the patient contacted her younger son and family for assistance. She became more depressed and started drinking two or three drinks at night to help her sleep and her son claimed that her decision-making ability was poor and contacted his attorney. The…
