Doctor: Welcome to the clinic. 
Patient: Thank you. It is nice to meet you.
Doctor: It is nice to meet you to. I hear an accent. Where are you from? 
Patient: I am from Denmark. I speak Danish as my first language. Me and my husband have been in the States for many many years. When we first got here, we did not speak a word of English. 
Doctor: Wow! Your English is excellent now. 
Patient: Thank you. 
Doctor: How old are you? 
Patient: I just turned seventy four last month. 
Doctor: Happy birthday! 
Patient: Thank you. 
Doctor: So, your primary care physician sent you here for possible hydrocephalus. 
Patient: Is that the water on brain thing? 
Doctor: Yes. 
Patient: Then, yes. 
Doctor: Can you tell me about the symptoms that you have been having. 
Patient: I think I have been walking funny lately. I have also been losing my balance.
Doctor: How do you know that you have been walking funny? 
Patient: My husband noticed that I have been walking funny. He noticed it about over six months ago or so. 
Doctor: What do you notice about the way your wife's walk that has changed?
Guest_family: She walks wider then she used to, and I noticed that she stooped over. She walks much slower than she did before. She is often losing her balance. I have noticed her touching the walls and furniture to stabilize herself. 
Doctor: Okay. Have you noticed her stabilizing herself all of a sudden? 
Guest_family: No. It has been happening more and more over the last six months or so. 
Doctor: What else have you noticed about the way she walks? 
Guest_family: I noticed that she is having trouble stepping up onto things like a scale. She seems very unbalanced. She also seems to take her time as she walks. She can't be hurried. 
Doctor: That is good that you are taking your time. Do you use any devices to assist you to get around? Like a cane or a walker? 
Patient: No. 
Guest_family: I must help her get in and out of the car. Not every time but sometimes. I am very concerned because she has been falling more and more recently.
Patient: I have had one emergency room visit. 
Doctor: What happened that you had to go to the emergency room? 
Patient: I fell. I was walking to the bedroom. I lost my balance so I put my hand out to brace myself against the wall and my hand slipped. I fell on my wrist. 
Guest_family: She broke her wrist.
Doctor: When did this fall happen?
Patient: March two thousand and seven.
Guest_family: She has fallen a few times since she broke her wrist. It makes me so nervous. 
Doctor: I can see why that would make you nervous. Have you had any headaches? 
Patient: No. I never get headaches.
Doctor: Aren't you lucky. 
Patient: Yes, I guess so. 
Doctor: Have you had any problems with your memory or cognitive abilities? 
Patient: I am still able to pay the bills on time. I don't feel as smart as I used to be.  I do feel like my thinking has slowed down over the last few months. 
Doctor: What is your perspective on her memory and her cognitive abilities? 
Guest_family: I have noticed some changes. She will occasionally start a sentence and then not know what words to use to finish the sentence. 
Doctor: Has she ever had trouble finishing a sentence the in the past? 
Guest_family: No, she has always been very well spoken never has lost thoughts. 
Doctor: Have you had any fainting or vertigo episodes? 
Patient: I have not fainted. I have had some dizzy spells in the past but not recently. 
Doctor: Have you had and problems with your bowel movements? 
Patient: No. 
Doctor: Any bladder issues or frequent urination? 
Patient: No. 
Doctor: Okey. Let us do some an exam. 
Patient: Okey.

Clinical note:
Symptoms: losing balance, stooping over, walking wider, walking slower, losing balance frequently, touching walls and furniture to stabilize, trouble stepping up onto things, unbalanced walking, slowing of speed, difficulty getting in and out of car, frequent falls, occasional dizziness, slowing of thinking, occasional difficulty finishing sentences.
Diagnosis: Possible adult hydrocephalus.
History of Patient: Patient presents with Symptoms of broadened base, stooped posture, declining balance over the last six months, frequent falls including one in March 2007 resulting in a broken wrist, occasional dizziness, slowing of thinking over the last few months, occasional difficulty finishing sentences.
Plan of Action: Examination indicated.