The Happy Grandmother
|You are asked to do a consultation of an 87 y.o. grandmother with Alzheimer's Disease and controlled hypertension at a nursing home. She has had two days of episodic bizarre behavior. Usually quiet, she has been repeating short phrases over and over again, swallowing air, flinging her right arm in a circular fashion, and making kissing gestures to the nursing staff. The episodes last about a half hour and occurred several times a day. She had a history of febrile seizures as a child. She had been given Haldol, but it had not helped. When examined, she is not having any episodes. She does not remember the episodes. Her physical examination shows the signs of hypertension, grade II eye ground changes, a heart that percussed 4 cm. to the left of the left mid-clavicular line, and a S4heart sound.|
On neurological exam, she was disoriented to year and month. She did not know the president, could not perform serial "7's" or serial "3's". Her gait was slow with some shuffling and a tendency to turn "en masse". There was no bradykinesia, not tremor, and no rigidity. She had prominent snout, suck and palmo-mental reflexes. Her motor and sensory examinations were normal. Her deep tendon reflexes were 2+ and symmetrical.