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The first three examples are provided by the Northwest Institute of Justice (NIJ):
The second set are from Protection & Advocacy, Inc. (PAI):
Alzheimer's Dementia late onset type with
depression DSM 290.21
The client has short-term memory losses that are consistent with Alzheimer's demenia and make learning
impossible. He is not able to study for and retain information for the
English language test or the U.S. history and civics test. He can converse
in Russian or Yiddish and is able to understand an oath of allegiance to
the USA.
DSM diagnosis. Dementia, Alzheimer type (DSM
290.0)
Patient has severe impairment of memory and higher level cognitive
functioning, including certain executive functions such as assimilating
and learning new information. I have done a complete medical work-up on
patient to come to this diagnosis. Alzheimer's Dementia is a diagnosis of
exclusion which requires proof that no other correctable or identifiable
cause explains her dementia. Patient showed severe memory problems by mini
mental status exam with a score of 17 out of 30. Through a Russian
interpreter she was simply unable to perform parts of the exam which
require memory and higher-level cognitive processing. Additionally, I was
able to rule out hypo-thyroidism, syphilis, Vitamin B-12 and Folate
deficiency, hematologic, electrolyte, and cardiac causes of dementia with
her normal test results on thyroid stimulating hormone, VDRL, Vit B12 +
Folate levels, complete blood count, electrolyte panel, electrocardiogram,
and chest x-ray.
Additionally, she has had carotid duplex studies to rule out carotid disease as a source of embolic stroke; these test were normal, as was her cholesterol level. I suggested one final study, a computed topography scan of the brain, to rule out multi-infarct dementia or mass lesion. Patient has isolated systolic hypertension making the formal diagnosis possible. However, she has had no documented stroke and has a normal neurological exam. Because patient would not undergo neurosurgery for a mass lesion, I felt it was appropriate no to push for a CT of her head.
Furthermore, a mass lesion would be a rare cause to explain her dementia when she has no localizing neurological signs. Patient did not want to have the CT scan, and I think that is appropriate. Patient has previously been evaluated for tinnitus by otolaryngology, and found to have presbyacusis and disequilibrium of aging. I doubt that either of these explains her dementia. Consequently, having ruled out other causes, I diagnose patient with Alzheimer's Dementia. Although she is competent currently to live on her own and competent to take the necessary oath, she has dementia that precludes her from being able to learn the information necessary for the citizenship test. Although competent, she requires help from her daughter for finances, remembering appointments, and other activities of daily living.
* Please allow patient's daughter to accompany her at any INS proceedings. (this request was denied)
The dementia and stroke significantly affect her physical and cognitive ability. Patient has short as well as long term memory deficits. She is not able to recall recent events from long past. She is not able to communicate her needs without prompting, nor is she able to answer complex or complicated questions or make decisions for herself. She does not have the mental or cognitive capacity to learn, speak or write the English language; and would not be able to memorize information or answer questions about government and history (civics) sufficient to pass the INS citizenship test. She is able to speak 2-3 English words and could speak her dialect in a limited way. Overall, she speaks very little as a result of her stroke and dementia.
The Patient Advocates Inc. Web site gives the following examples. The format they use is slightly different and more explicit. They outline the cause, the connection to a learning disability, and the consequence for learning English and the content for the history and civics exam.
CAUSE: Mrs. A. has congestive heart failure, atherosclerosis and high blood pressure. These conditions were diagnosed approximately three years ago.
CONNECTION: As a result of these conditions Mrs. A. has symptoms of extreme fatigue, recurrent pneumonia and debilitating headaches. As a result of her fatigue, frequent illness and headaches, she cannot attend English language or U.S. history and civics classes, and does not have the stamina to study on her own. Moreover, her fatigue and headaches make it impossible for her to concentrate enough to learn a new language or to memorize new information.
CONSEQUENCE: Mrs. A. is unable to pass the written or spoken English tests or the U.S. history and civics test in order to naturalize.
CAUSE: Mr. B. has vascular dementia secondary to arterial hypertension and heart disease, DSM IV 290.40. He was diagnosed in this office four years ago.
CONNECTION: Symptoms of his dementia include memory impairment (an impaired ability to learn new information or recall previously learned information), and cognitive disturbances, including an impairment of executive functioning, planning, sequencing, organizing and abstracting information. As a result of these symptoms, Mr. B. does not have the ability to learn a new language or to recall what he may have learned in the past.
CONSEQUENCE: Mr. B. is unable to pass the written or spoken English tests or the U.S. history and civics test in order to naturalize.
CAUSE: Ms. C. is blind and also has severe, recurrent depressive episodes with psychotic features, DSM IV 296.34.
CONNECTION: Ms. C.'s symptoms include fatigue, inability to concentrate and a sense of hopelessness. She also has delusions that her children are stealing from her. Her depression and delusions result in functional disability so that she is unable to leave her home due to fatigue and fear. As a result, she cannot attend classes to learn English or U.S. history and civics. She cannot initiate new tasks, such as studying from audio tapes. Her psychological symptoms also make it impossible for her to overcome the disability posed by her blindness.
CONSEQUENCE: As a result of the combination of her blindness and depression, Mrs. C. is unable to pass the written or spoken English tests or the U.S. history and civics test in order to naturalize.
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