Clinical ScenarioYou are about to s

Clinical Scenario
You are about to see a 76 year old retired school teacher for the second time. You first saw her in the clinic a month ago because of cognitive problems. Your evaluation at that time included a Standardized Mini Mental State Examination [1], on which she scored 18 out of a possible 30, and a physical examination which was normal including no focal neurological signs. You arranged investigations for the treatable causes of dementia which were negative, and you thus feel she has probable Alzheimer's disease.

She has lived with her son since her husband died six years ago. Her son thinks that she first developed significant problems with her memory about three years ago. However, she has become increasingly agitated and paranoid during the last year. She has refused to allow him to look after her financial affairs, despite the fact that she owns three pieces of property and isn't able to manage them herself. Her son asked you about her prognosis, and whether she is likely to die soon from the dementia. You indicated that you would discuss this with him at the second visit once the results of all the tests are available.