In taking his medical history, I learned that David had hypertension and high cholesterol. Though he was taking medication for both conditions, they weren't being adequately controlled. He had been to a hospital emergency department five months earlier with chest pain, which turned out to be benign. A recent physical examination, blood tests, and a chest x-ray were normal. His primary care physician had also ordered a brain MRI, which was normal.
David had a family history of cardiovascular disease; his father succumbed to a stroke at age sixty-six, and his mother had severe heart disease and had suffered multiple heart attacks. An older brother had recently undergone four-vessel cardiac bypass surgery. When I asked about any familial history of neurological problems, David recalled that his grandmother had become "senile" and was ultimately unable to remember names of family members or take care of herself. He then spontaneously commented, "You know, 96, it did occur to me that maybe I'm getting what she had."
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