Ref:Ref:
31415923141592
Dr
Dr
Dr
Kath
Kath
Kath
Middleton
Middleton
Middleton
DyadDyad
ClinicClinic
ChelseaChelsea
andand
WestminsterWestminster
HospitalHospital
369369
FulhamFulham
RoadRoad
LondonLondon
SW10SW10
9NH9NH

020020
33153315
81238123
katherine.middleton@dyad.netkatherine.middleton@dyad.net

13
13
13
October
October
October
2021
2021
2021
Dr
Dr
Dr
Oli
Oli
Oli
Maunsell
Maunsell
Maunsell
CodepilotCodepilot
SurgerySurgery
88
HermatigeHermatige
StreetStreet
LondonLondon
W2W2
1BE1BE


DearDear
Dr
Dr
Dr
Maunsell,
Maunsell,
Maunsell,

Alexia
Alexia
Alexia
Haberdasher
Haberdasher
Haberdasher
DOB:DOB:
10/1/1937
10/1/1937
10/1/1937
NHSNHS
No:No:
622622
778778
89898989

ThankThank
youyou
forfor
referringreferring
thisthis
rambunctiousrambunctious
elderlyelderly
ladylady
whomwhom
II
reviewedreviewed
todaytoday
inin
memorymemory
clinic.clinic.
Ms
Ms
Ms
Haberdasher
Haberdasher
Haberdasher
attendedattended
withwith
herher
niece,niece,
whowho
describesdescribes
aa
four
four
four
month
month
month
historyhistory
ofof
increasingincreasing
forgetfulness.
forgetfulness.
forgetfulness.
TheseThese
memorymemory
problemsproblems
relaterelate
toto
dailydaily
activitiesactivities
andand
seemseem
anterogradeanterograde
inin
nature.nature.
BothBoth
Ms
Ms
Ms
Haberdasher
Haberdasher
Haberdasher
andand
herher
nieceniece
denieddenied
anyany
signssigns
ofof
mood
mood
mood
disturbance
disturbance
disturbance
oror
hallucinations.
hallucinations.
hallucinations.
Ms
Ms
Ms
Haberdasher
Haberdasher
Haberdasher
liveslives
alonealone
inin
aa
shelteredsheltered
accommodation,accommodation,
withwith
dailydaily
check-inscheck-ins
byby
onsiteonsite
staff,staff,
walkswalks
withwith
aa
stickstick
andand
wearswears
aa
fallsfalls
pendant.pendant.
SheShe
isis
otherwiseotherwise
independentindependent
withwith
herher
ADLs.ADLs.
NotableNotable
medicalmedical
historyhistory
includeinclude
osteoporosis
osteoporosis
osteoporosis
withwith
aa
fracturedfractured
NOFNOF
inin
2019,
2019,
2019,
forfor
whichwhich
sheshe
receivedreceived
aa
hemiarthroplastyhemiarthroplasty
atat
CharingCharing
CrossCross
hospital,hospital,
andand
subsequentsubsequent
problemsproblems
withwith
venousvenous
drainagedrainage
inin
thatthat
leg.leg.
SheShe
hashas
nono
cardiovascularcardiovascular
history,history,
withwith
aa
normalnormal
cholesterol
cholesterol
cholesterol
measurementmeasurement
inin
September
September
September
2020.
2020.
2020.
Today
Today
Today
Ms
Ms
Ms
Haberdasher
Haberdasher
Haberdasher
scoredscored
1919
onon
MMSE.
MMSE.
MMSE.
II
notenote
fromfrom
youryour
referralreferral
letterletter
dateddated
August
August
August
2020
2020
2020
thatthat
sheshe
scoredscored
23,23,
suggestingsuggesting
declinedecline
inin
thethe
interiminterim
months.months.
HerHer
moodmood
waswas
brightbright
andand
sheshe
hadhad
capacity.capacity.
HerHer
PHQ-9
PHQ-9
PHQ-9
scorescore
waswas
4.4.
CardiovascularCardiovascular
examinationexamination
waswas
normalnormal
withwith
normalnormal
heartheart
soundssounds
andand
aa
mildlymildly
lowlow
BPBP
ofof
116/76.
116/76.
116/76.
ThereThere
waswas
nono
posturalpostural
drop.drop.
NeurologicalNeurological
examexam
foundfound
nono
evidenceevidence
ofof
unilateral
unilateral
unilateral
weakness
weakness
weakness
oror
sensory
sensory
sensory
abnormality,
abnormality,
abnormality,
nono
tremor,
tremor,
tremor,
facialfacial
expressionexpression
andand
speechspeech
normal.normal.
Ms
Ms
Ms
Haberdasher
Haberdasher
Haberdasher
underwentunderwent
aa
CT
CT
CT
scanscan
followingfollowing
ourour
clinicclinic
whichwhich
hashas
shownshown
generalisedgeneralised
cortical
cortical
cortical
atrophy
atrophy
atrophy
whichwhich
wouldwould
bebe
consistentconsistent
withwith
aa
diagnosisdiagnosis
ofof
moderatemoderate
Alzheimer’s
Alzheimer’s
Alzheimer’s
Dementia.
Dementia.
Dementia.
InIn
lightlight
ofof
mymy
clinicalclinical
findingsfindings
andand
thethe
CT
CT
CT
report,report,
II
wouldwould
likelike
toto
proposepropose
Ms
Ms
Ms
Haberdasher
Haberdasher
Haberdasher
isis
commencedcommenced
onon
aa
startingstarting
dosedose
ofof
memantine
memantine
memantine
5mg
5mg
5mg
once
once
once
daily,
daily,
daily,
whichwhich
wewe
maymay
looklook
toto
increaseincrease
eventually.eventually.
II
wouldwould
alsoalso
bebe
gratefulgrateful
ifif
aa
bloodblood
panelpanel
includingincluding
thyroidthyroid
andand
B12
B12
B12
couldcould
bebe
arrangedarranged
atat
youryour
surgery,surgery,
andand
toto
kindlykindly
letlet
mymy
secretarysecretary
knowknow
whenwhen
thosethose
resultsresults
areare
back.back.
II
looklook
forwardforward
toto
seeingseeing
herher
backback
inin
mymy
clinicclinic
forfor
reviewreview
in
in
in
3
3
3
months
months
months
time.
time.
time.

YoursYours
sincerely,sincerely,
Dr
Dr
Dr
Middleton
Middleton
Middleton