Upon entering the exam room, I saw the familiar faces of an elderly woman and her adult son who faithfully accompanied his mother to office visits. Her prior visits to the office consisted mainly of conversations about her quality of life, reviewing the results of routine labs and fulfilling her medication refill requests. However, this encounter was quite different.
As I sat down next to her, I felt that there was a disconnect between the mother and her son. A silence filled the room that I had never before among these two individuals. The son’s face appeared distraught and frustrated while his mother, who was a sweet, petite woman in otherwise good health at 79 years of age, seemed uneasy, sitting with both hands grasping the arms of her chair. Her body language gave the impression that she did not want to be in the building, let alone the room.
I immediately flashed back to our last visit several months ago, remembering that her son had mentioned subtle “changes” he witnessed about his mother’s memory and demeanor. At the time, I had a conversation with the patient about her well-being, activity level, and eating and sleeping habits. As usual, she always had no complaints and dismissed her son’s concerns over any changes. In fact, she told a story about her husband’s embarrassing attempt to court her with great detail, displaying exquisite long-term memory. I discussed with her and her son that after completing the labs, we would consider other testing if these “changes” continued.
Today, she was unrecognizable. She sat silently while her son described the recent events which involved the police being summoned by neighbors due to her irrational behavior after she had knocked on their doors. All episodes occurred when the son had briefly left the home to meet a client. She was sent to a hospital after several of such episodes, tests were conducted, and later she was released to her son. The hospital had coordinated a consultation with a specialist, and she was started on medications which unfortunately did not seem to improve her condition. In fact, she had been increasingly noncompliant with all of her medications.
Her silence finally broke when she politely asked to use the phone in the office to call her brother. I was aware