Recently an elderly man with significant cognitive impairment was brought to my office by his wife in the hope that there might be something to be done to improve his condition. Although on the surface he appeared cheerful, attentive and able to understand what was being said, it was the lack of coherence in his speech that betrayed how confused he really was.  Most any question that was posed him would be answered with a reply that started off well, but inevitably devolved into a sequence of words that made little sense.

His story was that about 5 years earlier, he had suffered a massive heart attack that he barely survived but since that time he no longer could think straight.  Previous to that he had a history of colon cancer about 15 years earlier, but there was no history of dementia.