Dr Mehta report June 2025

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615 Glenmary Ridge Road
Chattanooga, TN 37404

Harrowgate Neurology & Memory Clinic (423) 555-0144
harrowgateneuro.example

Memory Evaluation
June 16, 2025

Samuel Tolbert, MD
Tolbert & Greer Internal Medicine
Cleveland, Tennessee

Re: Lorraine M. Pruitt, date of birth 02/11/1945. Seen June 12, 2025, with her son.

Dear Dr. Tolbert,

Thank you for sending Mrs. Pruitt, an 80-year-old right-handed widow with 12 years of
education, for evaluation of memory loss.

History
Her son describes about two years of gradual decline: repeated questions, missed medications
without supervision, a stove left on twice this spring, and one episode of getting lost on a
familiar two-mile drive. She stopped managing her checkbook in 2023. She still dresses and
feeds herself, attends church and recalls remote events in detail. Mood has been better on
sertraline. She uses hearing aids. Her mother had "hardening of the arteries" late in life.

Examination
Alert, pleasant and well groomed. Speech fluent. Cranial nerves normal with hearing aids in
place. Strength full. Reduced vibration sense at both feet. Gait slow and slightly wide-based;
she uses a walker outdoors.

Montreal Cognitive Assessment: 19 out of 30. Points lost: delayed recall 0 of 5,
orientation 4 of 6, clock drawing 1 of 3, serial subtraction 1 of 3, verbal fluency 0 of 1, sentence
repetition 1 of 2. Naming and attention to digits were intact.

Functional Assessment Staging: stage 4.

Tests
Vitamin B12 and TSH from your office are normal. I have ordered an MRI of the brain without
contrast.

Impression
Mild dementia, most likely Alzheimer's disease, with a possible vascular contribution.
Plan
1. Start donepezil 5 mg at bedtime. If tolerated, increase to 10 mg at the three-month visit.
2. Stop gabapentin, which may be adding to dizziness and slowed thinking.
3. Supervision of medications should continue. I agree with the home aide and the medical
alert pendant.
4. Driving: short daytime trips on familiar roads only, to be reviewed at each visit. I will ask
for a formal driving evaluation if there is any further incident.
5. A kitchen range shutoff device is advised.
6. Powers of attorney are already in place (2023), with her son Walter Pruitt Jr. as agent.

I will see her again in three months.

Sincerely,

Rohan Mehta, MD

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Dr Mehta report June 2025 Document · saved Jun 29, 2025

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Value	Now
lorraine.date_of_birth	1945-02-11
hr-lorraine-2025-neuro-eval.date	2025-06-12

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Planted

only_in_file The extra-furosemide rule, one sentence on page 5 of the ten-page January 2025 discharge packet (one extra 20 mg tablet for a gain of 3 lb in a day or 5 lb in a week, call cardiology the same day, not more than two days running); the POA clause that lets Walt sell her house only after a physician's written statement and 30 days' notice to Russ; the principal balance on the September 2026 mortgage statement ($171,717.32); the memory test score (19 of 30); next year's drug plan premium ($46.20); the long-term-care daily benefit ($150); the 401(k) balance ($318,406.12 on June 30, 2026); every number on the September labs, which exist only as a portal screenshot (eGFR 33, A1c 7.9); the wind and hail deductible on Walt's house ($3,180); the owner and the title number on the Buick's title, which is a scan with no text (WALTER E PRUITT, 14 177 406219, no lien); the FMLA entitlement (480 hours for 2026); the lease clause that makes renter's insurance a condition, with $15 a month charged until proof is given; what Gentle Ridge has billed this year ($17,284.00 through September); mortgage interest paid in 2025 ($6,912.51); Camille's immunization dates.

attachments.yaml

record: doc-neuro-eval
template: document
org:
name: Harrowgate Neurology & Memory Clinic
lines:
- 615 Glenmary Ridge Road
- Chattanooga, TN 37404
phone: '4235550144'
web: harrowgateneuro.example
color: '#4a3f6b'
title: Memory Evaluation
body: 'June 16, 2025

Samuel Tolbert, MD<br>Tolbert & Greer Internal Medicine<br>Cleveland, Tennessee

**Re:** Lorraine M. Pruitt, date of birth {{lorraine.date_of_birth|mdy}}. Seen {{hr-lorraine-2025-neuro-eval.date}},
with her son.

Dear Dr. Tolbert,

Thank you for sending Mrs. Pruitt, an 80-year-old right-handed widow with 12 years of education, for
evaluation of memory loss.

## History

Her son describes about two years of gradual decline: repeated questions, missed medications without
supervision, a stove left on twice this spring, and one episode of getting lost on a familiar two-mile
drive. She stopped managing her checkbook in 2023. She still dresses and feeds herself, attends church
and recalls remote events in detail. Mood has been better on sertraline. She uses hearing aids. Her
mother had "hardening of the arteries" late in life.

## Examination

Alert, pleasant and well groomed. Speech fluent. Cranial nerves normal with hearing aids in place. Strength
full. Reduced vibration sense at both feet. Gait slow and slightly wide-based; she uses a walker outdoors.

**Montreal Cognitive Assessment: 19 out of 30.** Points lost: delayed recall 0 of 5, orientation 4 of
6, clock drawing 1 of 3, serial subtraction 1 of 3, verbal fluency 0 of 1, sentence repetition 1 of
2. Naming and attention to digits were intact.

Functional Assessment Staging: stage 4.

## Tests

Vitamin B12 and TSH from your office are normal. I have ordered an MRI of the brain without contrast.

## Impression

Mild dementia, most likely Alzheimer''s disease, with a possible vascular contribution.

## Plan

1. Start donepezil 5 mg at bedtime. If tolerated, increase to 10 mg at the three-month visit.

2. Stop gabapentin, which may be adding to dizziness and slowed thinking.

3. Supervision of medications should continue. I agree with the home aide and the medical alert pendant.

4. Driving: short daytime trips on familiar roads only, to be reviewed at each visit. I will ask for
a formal driving evaluation if there is any further incident.

5. A kitchen range shutoff device is advised.

6. Powers of attorney are already in place (2023), with her son Walter Pruitt Jr. as agent.

I will see her again in three months.

Sincerely,

Rohan Mehta, MD