8-25-2002 16:05 JOHNS HOPKINS NEUROLOGY + s17O3S7I4276 i vy 103-0 _ 0.885 peal Ae. ¥ Johns Hopkins Medicine CLINIC NOTE Bistary: 6.307.85556 3650 Gunston Road Vist Date: o71nsi2002 ‘Alerandia VA 22302 (70s)6n1-4274 anpsi9s0 Location: ur Race: White b4e4s10030 Sec Male Primary Provider: OBrien Richard Josep Reston or Vis selena for ollowp visit felowing his recent dlagnostc evasion a History of Preseat Dives: {spent approitatly 45 mists widh Mr ming though his recent sb test and lied sna, Ta issues raed ae follows hls curent ist, by cognitive teng bots by mind ad by his previous nsropayeiaee trig, Mr. lima ealy has citise gave sbnormaiies, These involve angutge, memory aod constuction, Hebad «MRI done nee at Hoplixs, ‘which ke bis previous MRY, shows dius volume fos and a PET scan which shows bate, lef greter thc ht, ‘emporopssical bypomeaboism consistent with erly Akzei’'s disease. is clinical tory, eogalive tetng, MRI and PET seas are ll consistent with progressive murodegencrative proctts, Tae mostly of there woul be Albheimers disease as previously docuzestod the sbeetfeatres of opiotmpora dementia i his ea, [Kis clea from our knowledge of Alsheina’sdsese thie deeaé ean progress vary slowly for many years. Tn addition, ‘his diate, int eaves stages, manifest selfs bom having difclly balancing ever ask atone time. 1 ‘derstand fom the putict and bis records that he had éiicaly maintaining hie iw practice several yess ng, nd a, ‘bed some legal dficuldes eraming fom this. Iti in my proetsional pinion, quit key tht much of is difclty ‘atime wan the begining manifestations of his degenerative neurologic proezs, Ttis wel nown tat Alsbelsers cam bein its calor sages for many yrs before it i elncally étetable and piven te sigicant deficits he bes is ota iis ely dat he wae sigaleastiy impaled several yea exe, “Toe second nue wth Aa se bis eno malfresin, Ta Ms MRE peseaedthe ‘prove conrence uate ced sare i doors Mgphy tnd Gallia “Ty both fel a is sy » venous malforation aboogh ceasigeely age ont Iti ely that here is ce bit of venons hypertension stocited wih hs and Wat he a Some Hie for avebos aft vn age August 2002 FINAL DOCUMENT2205/2082 14:05 JOHNS HOPKING NEURCLOGY » si7@s6TIaz76 ; C C Patient: SoS 2 History # 6-347-85-56, N0.565 pea2 Deerer tr feel hat thre is sigicat interven) or spi! weamnet for his, give th fact hat itis venous utfow fomnormal ban, tof heir concer is more for he fact hat itmight temboceeausage seek ine pies ato ma, hey nd Tbave ecommzuded apps, Bob he arauadciogisneosepron et cue {leat vezous mlfrmaton may cont sgh, bs ote ese of is npn een. wens ole ue toa neurodepeneratve cea as aeaboued Medications: Allergies: Major Findings: ‘Assesnmente: {eave reconsaendnd to Mi. aig that eke visminE 1000 unis bi, Reming! tanag st 4g bid to advance {912 mg bid. and finally that be take Liptor, a colatral lowering agect because of ts pores bocv is ‘Azbeimy a 10mg qu, He wil continued tobe fllowed by hs loa dottor and Iwllooe hie tect 4 ‘ont, ProblensDiageeis: Procedures and Inumuciztion: Phan ‘Mediation Changes; ecList: DICTATED BY; YBRIEN, RICHARD JOSEPH, MD./717D: o7/0S72002 1: o7/0712002 Provider O'BRIEN, RICHARD. ovesr002 ‘TES DOCUMENT HAS BEEN ELECTRONICALLY SIGNED. ‘August 52002 FINAL DOCUMENT