Question of the Week # 167

167)  A 77 year old woman is brought by her son for evaluation in your office for excessive forgetfulness.  Her son discovered that the patient has become increasingly forgetful over the last two years. She has difficulty managing her finances. She lives alone, drives her own car and prepares her own meals. As per her son, several recent new dents were noted on her mother’s car. She is dressed well and is comfortable. Visual acuity on examination is 20/40 in both eyes. She has seen her ophthalmologist recently and was prescribed corrective glasses which correct her vision to normal. She is compliant with using her glasses during driving. Rest of the physical including sensory and motor functions are grossly normal. She scores 25/30 on Mini-Mental Status examination.

The most appropriate recommendation regarding her driving at this time:

A)     Limit driving to day-time only

B)      Unrestricted driving

C)      Complete cessation of driving

D)     Referral to Driving Rehabilitation Service

E)     Start therapy for Alzheimer’s

15 Responses

  1. A) Limit driving to day-time only ,bcoz of forgetfullness

    • wrog

  2. k

  3. b, she is functioning other than forgetfulness than why should she be restricted

  4. she could not see properly so the dents now she can see and vision normal so i guess b.

  5. E………

  6. Isn’t 25/30 passing score on the mini mental?

  7. isnt it breaking confidentialy to prevent harm to others….

  8. D need to take test again

  9. C since she has become excessively forgetful. She may forget which way she was driving and drive in the direction of coming traffic and not only kill herself but also someone else. She should not be driving.

  10. Ans = B
    Pt lately cleared by ophthalmologist with corrective lenses and she is using this. Her MMS score is 25/30.
    MMS score interpretation.
    A. 9 or below 9 = Severe dementia
    B. 10-20 moderate
    C. 21-24 severe
    As she has normal MMS score and corrected vision (which could be the cause of dents on car) so I think unrestricted driving is correct ans.

  11. Her son discovered that the patient has become increasingly forgetful over the last two years. She has difficulty managing her finances.

    confused abt this?

    should her driving be restricted even if mms is normal?

  12. MMSE is normal. Her vision is normal with corrective glasses. I don’t think she should be restricted from driving. B)

  13. Signs of mild AD can include the following:

    Memory loss
    Confusion about the location of familiar places
    Taking longer to accomplish normal, daily tasks
    Trouble handling money and paying bills
    Compromised judgment, often leading to bad decisions
    Loss of spontaneity and sense of initiative
    Mood and personality changes; increased anxiety

    Means of diagnosing AD include the following:
    – Clinical examination: The clinical diagnosis of AD is usually made during the mild stage of the disease, using the above-listed signs

    http://emedicine.medscape.com/article/1134817-overview

    I would want to start treatment for her mild/early Alzheimer’s to prevent morbidity.
    http://emedicine.medscape.com/article/1134817-treatment#aw2aab6b6b2

    When to stop driving?
    Mild Alzheimer’s is not a hard-fast indication to stop driving. It depends on the patient’s overall well-being; in this case, she lives alone and with a relatively normal MMSE (which cannot be used solely to diagnose), it may be permissible for her to take short daytime trips to achieve her basic daily necessities.

    http://www.mayoclinic.org/healthy-living/caregivers/in-depth/alzheimers/art-20044924

    In conclusion, my answer is E.

    • pls do not over Dx AH to all old Pt that forget a few things; 77yo starts to struggle with regular life task and memory – she start to be slower, less reflexes during driving their is a time where things get harder and sloppier than they use to be MME–no cognitive impairment=24-30; mild cognitive impairment=18-23; severe cognitive impairment=0-17. –she has normal MME –but she has 77yo . She lives alone, drives her own car and prepares her own meals, She dresses well– She is compliant with using her glasses during driving(meaning she does not forget to use her glasses during driving) –just make sure to be safe for Pt and others –D) Referral to Driving Rehabilitation Service- to make sure that her driving skills are still there

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