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BECKETT SIMON Dav
Anthony Price [Dav
Anthea Fraser [Dav
Conrad, Dav
Durham,Dav
Clare James Wednesday (epub)
[Gail Carriger] Changeless
Birago Diop Contes et Lavanes
Annette Curtis Klause The Silve
[heft] Perry Rhodan 2153 Die Tributschmiede

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.I shook my head no."You really must try it.We really love that restaurant.They have the best meals.""What do you like to eat there?" I asked her, doing my Columbo routine."Oh, I like everything.""What did you eat last time you were there?"Ruth stared at me blankly.I imagined her flipping through her mental calendar and finding every page blank.Eventually she looked to her husband for assistance."We had the Peking duck, Doctor.""That's right, the Peking duck." Ruth seemed pleased with herself, as if she was the one who had recovered the memory."It was so good.You really have to try it."I smiled and said I would.The conversation, however, was troubling.Despite her preserved social graces, it was becoming increasingly apparent that Ruth had some issues with her shortterm memory at the very least.Though she skillfully hid it by deferring to her husband, the more I continued to isolate her from his coaching, the more apparent it became.The simple memory tests I gave her next only confirmed my suspicions.I gave Ruth a piece of paper and a pen."I'm going to ask you to draw me a large circle and pretend it is a clock.Please put the numbers on the clock."It's a simple task that any grade school student should be able to perform, but Ruth struggled with it.Robbed of her husband's assistance, she painstakingly placed the numbers on the clock, pausing to consider the position of each one as if her very life depended on it.Perhaps, in a way, it did.After a minute, she looked up at me with a sense of accomplishment.Like a student proudly giving an aced test to a parent, she handed me the piece of paper.I looked down at her work and noted that the numbers one through twelve had been placed correctly on the clock.Then I handed the paper back to her."Now I want you to draw the hands on there at 2:45."My request was met with a concerned smile.Ruth's eyes drifted up toward the clock above the doorway.She studied it momentarily before speaking."Doctor, I don't know how any of this has anything to do with me.I'm fine, really.I don't know what my husband is going on about.""Mrs.Rubenstein, I know it seems silly, but the test can really be helpful to me in figuring out what is going on.Could you just place the hands of the clock at 2:45, please?"Ruth sized me up.I refused to back down.She looked back at her drawing and shook her head, as if frustrated by the inconsequential nature of my request.She considered the numbers on the page."What time do you want?""2:45."Over the next minute, the mental strain of the activity became more obvious.She tapped her pen on the paper.Intermittently she broke the silence with nervous laughter."I was never really good at math," she announced.I didn't have the heart to tell her that the task had more to do with visual-spatial skills and executive function than math.The clock test is standard for just that reason: If you can do it, the chances are excellent you don't have Alzheimer's.It's also a highly significant indicator of how you will do on the road.I wish the DMV would give this test along with the eye exam.I waited patiently for Ruth to finish.Finally, after several minutes, she drew the little hand pointing to the 2.Then, like thousands of other patients with memory impairment, Ruth placed the minute hand of the clock between the 4 and 5, rather than at the 9.Convinced that she had once again aced her exam, Ruth looked up at me with a sense of extreme satisfaction.As I looked over at her husband, it was apparent that he didn't share her enthusiasm.A tear had come to his eyes, which he quickly wiped away before it could find its way down his check.I then launched immediately into another battery of memory tests without saying a word about her performance.She seemed momentarily disappointed by the lack of feedback, but there is nothing much that I can say in that situation--nothing that the patient wants to hear, anyway."All right, Mrs.Rubenstein, I'm going to say three words and ask you to commit them to memory."I recited three words--apple, book, and coat--and asked her to repeat them back to me.She remembered two out of three.Five minutes later, she would almost certainly remember none.I asked her to spell a five-letter word, world, forward.She did so, quickly and precisely.A smile that said "I told you there is nothing wrong with me" appeared on her face."Now can you spell it backward?" I asked.She looked at me with the sort of lethal stare she gave her husband earlier."Doctor, I don't understand why any of this is necessary.I'm totally fine."I repeated my request and she continued to struggle; she was finally able to get only two of the five letters in place.Switching gears to another memory test, I asked her to write down the names of as many four-legged animals as she could in a minute.Normally, patients can name over ten in this test of executive function.Today, my five-year-old son could probably name twice that, but Ruth named only six that day and wrote cat down twice.We finished a few additional tests and I asked Frank to escort me to the waiting area so I could conduct a more thorough physical examination.He seemed reluctant to leave, but did so grudgingly after his wife gave him a reassuring smile."It's okay, dear.It's just part of the exam," she said.In the hallway, I used the opportunity to openly ask Frank some harder questions about his wife.I have learned over the years that there are many things family members do not want to disclose in front of the person suspected of having dementia."Has she done anything dangerous?" 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