3 AM and I’m wide awake

I’m frustrated.

I have to write a note on a potential dementia patient. History was equivocal. Exam was unremarkable. The neuropsychology student who tested him on Thursday disappeared without giving me any information (“I have to score it!”) and then on Friday I found her before Grand Rounds and she promised to give me a photocopy of her papers. And then she disappeared on Friday as well.

So here I am at 3 AM, early Saturday morning, trying to figure out if I want to call him mild cognitive impairment or frank dementia, which oh-by-the-way requires NEUROPSYCH TESTING.

I hate flaky people. Partly because their flakiness will make me look incompetent in my note and when I present him to the entire clinic at Monday morning case conference. But the bigger thing is that getting the diagnosis right in this guy really does matter. If he’s mild cognitive impairment, there are things we can do — mostly lifestyle changes — to decrease his risk of conversion to dementia (10-12% per year!). If he’s dementia … well, there’s always Aricept.


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