HISTORY: This is a 77-year-old gentleman with a known significant past medical history of coronary artery disease status post CABG, MI, diabetes mellitus, hypercholesterolemia, chronic renal failure, and senile dementia most likely of the Alzheimer type who was seen today for a followup. The patient was accompanied by his wife today. The patient's wife stated that he has been forgetful and he repeats himself at times. The patient is currently taking Aricept 10 mg q.h.s., aspirin, and Plavix for stroke prophylaxis. The patient had an MRI of the brain. The patient had a carotid Doppler scan done at Community Hospital, which showed significant carotid stenosis of the right internal carotid artery for which he is currently being followed by vascular surgeon. The patient is scheduled for an MRA of the carotid arteries. The patient stated that he cannot go for surgery because of his severe restriction of cervical spine related to motor vehicle accident that he had in 1975. The patient has severe restrictions of cervical spine in all directions. The patient denied any bladder and/or bowel incontinence during the day. The patient has been feeling okay. The patient did not take the Zoloft and did not take the temazepam.

PHYSICAL EXAMINATION: Physical examination today was essentially unchanged. The patient had cranial nerves examination II-XI was within normal range. The patient had 5/5 in all muscle groups of the upper and lower extremities. The patient was able to heel?walk and tiptoe. The patient's deep tendon reflexes were 1+ symmetrical and equal all through. Plantar responses were flexors. The patient was alert and oriented x3 and current with all political figures and current events up to date.

DIAGNOSTIC TESTING: MRI of the brain showed microvascular cerebral vessel disease of a mild degree. Peripheral neuropathy and vasculitis workup was unremarkable. Carotid Doppler scan showed severe carotid disease involving the right internal carotid artery with moderate to severe compromise of the lumen requiring surgical evaluation.

PLAN: The patient was advised to continue with the current dose of Ecotrin and Plavix. The patient will take Aricept 10 mg q.h.s. The patient was advised to go for an MRI of the cervical spine since he is being evaluated for carotid endarterectomy. The patient will return back for a followup after the above workup is completed. The patient will take Zoloft on a p.r.n. basis for severe anxiety related to psychosocial stressors.

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