CHIEF COMPLAINT: Change in Mental Status

PRESENT ILLNESS: 74 yo M w history of alzheimers dementia, CAD, noted to be
increasing restless and his usual daycare. Was also agitated and
combative. Upon nurses assesment, pupils noted to be rolled back
in his head, and patient noted to have shaking tremors of lower
extemities.  All events witnessed by pt's wife and daughter who
were at Day Care withthe patient. Temp taken at Day care
registered at 103.1.  BP 130/82.  Family denied loss of
continence.  No LOC, family states that they were able to
communicate with the patient during the shaking episode.
.

MEDICAL HISTORY: Dementia
CAD s/p CABG [**49**] yrs ago
Osteoarthritis
B 12 deficiency
H/O afib
h/o recent toe cellulits RLE tx'd with 14 days of PO Keflex.

MEDICATION ON ADMISSION: Lasix 80mg qd
Simvastatin 40 mg qhs
KCl
MVI
Vit B12 SC q month
donepezil 5mg qhs
ASA 81mg qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 102.4R, T99.5 axillary, BP 94/62; HR 88; 99%RA
Gen: lethargic male, diaphoretic in bed
HEENT: dry MM. Perrla, EOMI, but has trouble following commands
CV: tachy. reg s1 and s2. 2/6 systolic murmur best audible at
RUSB
CHEST: CTAB. No rales, rhonchi wheezes
ABD: + BS. Soft, NT, ND, no HSM.
EXT: bilat LE edema, but RLE > LLE signifcantly.  warmth and
erythema from R dorsal surface all the up to the knee. no
palbable chords.  No [**Last Name (un) 5813**] sign elicited.
LLE: [**Name (NI) **] PT and DP
RLE: [**Name (NI) **] PT and DP
NEURO: not able to cooperate with neuro exam.  patient is
lethargic, but arousable, does not follow commands, but able to
respond to the family (this is off baseline, family states).
moves all 4 extremities (though not on command). no neck
stiffness

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Pt lives at home with his wife and homemakers. Advance dementia,
but pt is able to dress and toilet himself (including shaving
his face and body). lifetime non-smoker and non-drinker.
Baseline ambulatory and able to participate in daycare
activities
Unspecified septicemia,Cellulitis and abscess of leg, except foot,Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Atrial fibrillation,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Other B-complex deficiencies,Aortocoronary bypass status,Severe sepsis
Septicemia NOS,Cellulitis of leg,Ac on chr diast hrt fail,Acute kidney failure NOS,Food/vomit pneumonitis,Atrial fibrillation,Alzheimer's disease,Dementia w/o behav dist,B-complex defic NEC,Aortocoronary bypass,Severe sepsis
Name:  [**Known lastname 6054**],[**Known firstname **] N.                Unit No:   [**Numeric Identifier 6055**]

Admission Date:  [**2141-9-29**]              Discharge Date:   [**2141-10-6**]

Date of Birth:  [**2066-12-21**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2403**]
Addendum:
On arrival to medical floor, patient was hypotensive,
tachycardic, with elevated WBC in the setting of a known
infection (cellulitis).  Thus, he met criteria for sepsis and
was transferred to the intensive care unit for further
management of his sepsis.

Discharge Disposition:
Home With Service

Facility:
[**Hospital 197**] [**Name (NI) 198**]

                             [**Name6 (MD) **] [**Last Name (NamePattern4) 2404**] MD [**MD Number(2) 2405**]

Completed by:[**2141-10-26**]

Admission Date:  [**2141-9-29**]              Discharge Date:   [**2141-10-6**]

Date of Birth:  [**2066-12-21**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 545**]
Chief Complaint:
Change in Mental Status

Major Surgical or Invasive Procedure:
none

History of Present Illness:
74 yo M w history of alzheimers dementia, CAD, noted to be
increasing restless and his usual daycare. Was also agitated and
combative. Upon nurses assesment, pupils noted to be rolled back
in his head, and patient noted to have shaking tremors of lower
extemities.  All events witnessed by pt's wife and daughter who
were at Day Care withthe patient. Temp taken at Day care
registered at 103.1.  BP 130/82.  Family denied loss of
continence.  No LOC, family states that they were able to
communicate with the patient during the shaking episode.
.


When EMS arrived to daycare, pt noted to be more restless, very
talkative, twitching leg movements, agitated, combative.  EMS
arrived, found the patient  FS noted to be 58, given [**1-17**] amp
D50, BS improved to 166. Taken to [**Hospital1 18**] ED.
.
Pt baseline is not oriented, doesn't recognize family due to his
dementia, but is able to take care of ADLs (shaving, toileting,
eating).  Family reports patient entirely at baseline day prior
to admission, doing well, having gone to Temple during the
[**Hospital1 **] Holidays.  The lethargy and increased agitation is new
for the patient and is especially concerning given the high
fevers.
.
Unable to obtain ROS from the patient.  Per family, pt does not
have any CP, SOB, abd pain.  They did mention that patient does
occasionally c/o pain in his legs.  Denied cough, headaches,
dizziness, lightheadedness, nausea, vomiting, diarrhea.
.

In ED, T 103; HR 96; BP 130/70; RR 24; O2 sat 98% 2L NC.  no
localizing symptoms, but difficult to assess given pt's
dementia. LP was peformed and was negative.  BCx were taken. UA
negative. A dose of ceftaz and vanco were given empirically
given the pt's delta MS, fevers, bandemia. EKG significant for
sinus tach 102, LAD, no significant ST-T segment changes.


Past Medical History:
Dementia
CAD s/p CABG [**49**] yrs ago
Osteoarthritis
B 12 deficiency
H/O afib
h/o recent toe cellulits RLE tx'd with 14 days of PO Keflex.

Social History:
Pt lives at home with his wife and homemakers. Advance dementia,
but pt is able to dress and toilet himself (including shaving
his face and body). lifetime non-smoker and non-drinker.
Baseline ambulatory and able to participate in daycare
activities

Family History:
non-contributory

Physical Exam:
VS: T 102.4R, T99.5 axillary, BP 94/62; HR 88; 99%RA
Gen: lethargic male, diaphoretic in bed
HEENT: dry MM. Perrla, EOMI, but has trouble following commands
CV: tachy. reg s1 and s2. 2/6 systolic murmur best audible at
RUSB
CHEST: CTAB. No rales, rhonchi wheezes
ABD: + BS. Soft, NT, ND, no HSM.
EXT: bilat LE edema, but RLE > LLE signifcantly.  warmth and
erythema from R dorsal surface all the up to the knee. no
palbable chords.  No [**Last Name (un) 5813**] sign elicited.
LLE: [**Name (NI) **] PT and DP
RLE: [**Name (NI) **] PT and DP
NEURO: not able to cooperate with neuro exam.  patient is
lethargic, but arousable, does not follow commands, but able to
respond to the family (this is off baseline, family states).
moves all 4 extremities (though not on command). no neck
stiffness


Pertinent Results:
<b>Admit Labs:</b>
[**2141-9-29**] 03:30PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-100 KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-7.0
LEUK-NEG
[**2141-9-29**] 03:30PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.014
[**2141-9-29**] 03:30PM   PLT COUNT-192
[**2141-9-29**] 03:30PM   HYPOCHROM-OCCASIONAL ANISOCYT-OCCASIONAL
POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL
POLYCHROM-NORMAL
[**2141-9-29**] 03:30PM   NEUTS-90* BANDS-3 LYMPHS-4* MONOS-3 EOS-0
BASOS-0 ATYPS-0 METAS-0 MYELOS-0
[**2141-9-29**] 03:30PM   WBC-16.1* RBC-4.38* HGB-14.5 HCT-40.6 MCV-93
MCH-33.0* MCHC-35.6* RDW-14.3
[**2141-9-29**] 03:30PM   CALCIUM-9.3 PHOSPHATE-2.2* MAGNESIUM-2.3
[**2141-9-29**] 03:30PM   ALT(SGPT)-17 AST(SGOT)-30 ALK PHOS-95
AMYLASE-98 TOT BILI-1.0
[**2141-9-29**] 03:30PM   estGFR-Using this
[**2141-9-29**] 03:30PM   GLUCOSE-138* UREA N-14 CREAT-0.9 SODIUM-138
POTASSIUM-3.9 CHLORIDE-96 TOTAL CO2-32 ANION GAP-14
[**2141-9-29**] 03:57PM   GLUCOSE-136* LACTATE-1.3 K+-3.7
[**2141-9-29**] 03:57PM   COMMENTS-GREEN TOP
[**2141-9-29**] 09:50PM CEREBROSPINAL FLUID (CSF)  WBC-2 RBC-2* POLYS-1
LYMPHS-15 MONOS-81 MACROPHAG-3
[**2141-9-29**] 09:50PM CEREBROSPINAL FLUID (CSF)  PROTEIN-186*
GLUCOSE-77
[**2141-9-29**] 10:33PM   LACTATE-1.3
[**2141-9-29**] 10:33PM   COMMENTS-GREEN TOP
<br>
<b>Other Labs:</b>
[**2141-10-1**] 05:40PM BLOOD CK(CPK)-649*
[**2141-10-2**] 06:00AM BLOOD CK(CPK)-497*
[**2141-10-3**] 10:00AM BLOOD ALT-17 AST-30 LD(LDH)-241 CK(CPK)-234*
AlkPhos-66 TotBili-0.6
[**2141-10-1**] 05:40PM BLOOD cTropnT-<0.01 proBNP-2987*
[**2141-10-2**] 06:00AM BLOOD cTropnT-0.01
[**2141-9-29**] 03:30PM BLOOD Cortsol-46.1*
[**2141-9-30**] 06:26AM BLOOD Cortsol-19.4
[**2141-9-29**] 03:30PM BLOOD TSH-0.65
[**2141-9-30**] 08:01PM BLOOD Type-ART Rates-/26 FiO2-92 O2 Flow-4
pO2-65* pCO2-36 pH-7.42 calTCO2-24 Base XS-0 AADO2-567 REQ O2-92
Intubat-NOT INTUBA Comment-NASAL [**Last Name (un) 154**]
[**2141-9-30**] 08:01PM BLOOD Glucose-135* Lactate-0.9 Na-137 K-3.3*
Cl-108
[**2141-10-1**] 05:35PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.022
[**2141-10-1**] 05:35PM URINE Blood-LGE Nitrite-NEG Protein-30
Glucose-NEG Ketone-50 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2141-10-1**] 05:35PM URINE RBC-74* WBC-0 Bacteri-MOD Yeast-FEW
Epi-<1
[**2141-10-1**] 05:35PM URINE Mucous-OCC
<br>
<b>Micro Data:</b>
Urine Cx ([**9-29**]) - Negative
Blood Cx ([**9-29**]) - Negative x 2
CSF Cx ([**9-29**]) - negative
RPR ([**9-30**]) - negative
Blood Cx ([**10-1**]) - no growth to date x 2 (final results pending)
Urine Cx ([**10-1**]) - negative
<br>
<b>Studies:</b>
CXR: [**9-29**]:
FINDINGS: Upright portable chest radiograph is obtained. Midline
sternotomy
wires and mediastinal clips are noted, likely related to prior
CABG. The
lungs are clear bilaterally, demonstrating no evidence of
airspace
consolidation, effusion, or CHF. There is minimal subsegmental
atelectasis at the left lung base, likely in the left lower
lobe. The cardiomediastinal silhouette is unremarkable. The
visualized osseous structures are intact. Bowel gas pattern in
the upper abdomen is unremarkable.
IMPRESSION:
No acute intrathoracic process
<br>
CHEST (PORTABLE AP)  [**2141-9-30**] 8:12 PM
Single AP view of the chest is obtained supine on [**2141-9-30**] at
[**2053**] hours and is compared with the most recent study performed
the prior day. Again seen evidence of prior cardiac surgery.
There is mild pulmonary vascular congestion which may be in part
due to the supine position and underinflation of the lungs but
fluid overload or early failure would be a concern. The degree
of respiratory motion in the chest makes evaluation of the lower
lung fields suboptimal however there is a patchy increase in
lung markings at both bases.
IMPRESSION:
Findings are likely a combination of the underinflation, supine
position and some fluid overload. Recommend a repeat examination
when the patient condition permits to exclude developing
airspace disease at both bases.
<br>
UNILAT LOWER EXT VEINS RIGHT  [**2141-9-30**] 3:44 AM
RIGHT LOWER EXTREMITY ULTRASOUND: Grayscale and color Doppler
son[**Name (NI) 1417**] of the right common femoral, superficial femoral, and
popliteal veins was performed. There was normal flow,
augmentation, compressibility, and waveforms demonstrated. No
intraluminal thrombus was identified.
IMPRESSION: No evidence of right lower extremity deep vein
thrombosis.
<br>
CHEST (PORTABLE AP)  [**2141-10-1**] 5:50 PM
IMPRESSION: AP chest compared to [**9-30**] and earlier on [**10-1**]
symmetrical opacification in the lower lungs has developed over
the past two days, due in part to small increasing bilateral
pleural effusion. This could be either dependent edema or
aspiration, more likely the former given some slight increase in
mild pulmonary vascular engorgement. No pneumothorax.
<br>
Head CT [**9-29**]: EAD CT WITHOUT CONTRAST: There is no comparison.
The study is somewhat degraded due to motion artifact. There is
no acute intracranial hemorrhage or mass effect. There is
generalized brain atrophy with slightly prominent ventricles,
with periventricular white matter hypodensity densities, likely
due to prior chronic small vessel ischemia. There is mild
mucosal thickening in the ethmoid sinus. Otherwise, the
surrounding osseous and soft tissue structures are unremarkable.

IMPRESSION: No acute intracranial hemorrhage. Chronic small
vessel ischemia.
<br>
TTE ([**10-2**]):
Conclusions:
The left atrium is normal in size. No atrial septal defect is
seen by 2D or color Doppler. The estimated right atrial pressure
is 5-10 mmHg. Left
ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF >55%) Transmitral Doppler and
tissue velocity imaging are consistent with Grade I (mild) LV
diastolic dysfunction. There is no ventricular septal defect.
Right ventricular chamber size and free wall motion are normal.
The ascending aorta is mildly dilated. The aortic valve leaflets
(3) are mildly thickened but aortic stenosis is not present. No
aortic regurgitation is seen. The mitral valve leaflets are
mildly thickened. There is no mitral valve prolapse. Trivial
mitral regurgitation is seen. The left ventricular inflow
pattern suggests impaired relaxation. There is mild pulmonary
artery systolic hypertension. There is an anterior space which
most likely represents a fat pad.
<br>
CHEST (PA & LAT)  [**2141-10-4**] 9:28 AM
IMPRESSION: Resolution of pulmonary vascular congestion. Pleural
effusions and associated bibasilar atelectasis persist.
<br>
<b>Discharge Labs:</b>
WBC-7.7, Hct-38, Plt-277
Na-142, K-3.3, Cl-101, HCO3-34, BUN-20, Cr-1.3, Gluc-106,
Ca-9.1, Mg-2.7, Phos-2.8, Alb-3.3

Brief Hospital Course:
1) RLE Cellulitis
Initially treated with Vanc/Ceftaz for cellulitis.  Later
changed to Vanc and Unasyn and subsequently Vanc and Zosyn.
Initially some concern for DVT.  Pt placed on heparin drip.
Lower extremity dopplers negative as above and heparin stopped.
Over the course of hospitalization, cellulitis improved and on
discharge there was only minimal area of erythema.
<br>
2) Hypotension
On arrival to the floor, pt was hypotensive w/ SBPs in 80s.  He
was given aggressive IV hydration and went to ICU.  There,
patient received aggressive IV hydration and blood pressure
improved to 110s.  He was subsequently transferred to the floor.
<br>
3) CHF, diastolic, acute on chronic/Acute Renal Failure
After patient was transferred to the floor, his O2 sat was
decreased (92% on RA) and he had significant secretions.  Along
with this he was very lethargic.  Clinical exam and CXR were
consistent with volume overload and pulmonary congestion.  He
was diuresed with IV lasix over the next couple of days with
improvement in his overall respiratory status.  His Cr went up
(from 0.8 to a peak of 1.5).  Due to this, his Lasix was held on
the 2 days prior to discharge, however restarted on the day of
discharge when his Cr was back to 1.3.  He had a repeat TTE with
the results as above (preserved systolic function with Grade I
diastolic dysfunction).  Prior to discharge, his respiratory
status was stable and he was breathing comfortably on room air
with O2 sats in the mid to high 90s.
<br?
4) Pneumonia, question aspiration
After transfer to the floor on [**10-1**], patient had fever of 103,
thick secretions, and CXR that raised question of aspiration
pneumonia.  Based on these findings, his antibiotics were
changed to Vancomycin and Zosyn.  He was continued on these for
a few days until he remained afebrile with improved respiratory
status.  He was subsequently changed to Levaquin and Flagyl to
complete a 10-day course.  He was evaluted by speech and swallow
and was cleared for a regular diet due to no evidence of
aspiration on bedside evaluation.  He still had significant
secretions so is being discharged with a home suction machine.
Consider Scopolamine patch if patient continues to have
significant secretions.
<br>
5) MS changes
Likely due to fever (source most likely RLE cellulitis).  On
initial arrival on the floor, pt was febrile w/ hypotension.
Also had hypoglycemia (FS of 58).  TSH, B12, Folate, RPR, head
CT all checked and unremarkable as above.  He had an LP done in
ED w/ unremarkable results as above.  During the initial part of
his hospitalization his mental status fluctuated from being
agitated (requiring restraints and sitter) to being lethargic
and minimally responsive. Family resisted haldol, so this was
not given.  Once he was treated for infection, his mental status
improved and returned back to baseline.
<br>
6) Dementia, Alzheimer's type
Per family, pt is not oriented at baseline.  As above mental
status varied, though back at baseline on discharge.  He was
continued on Namenda and Aricept during hospitalization.
<br>
7) CAD
No active issues.  Continued on asa 81mg and simvastatin.
<br>
Outstanding issues:
-f/u final blood culture results from [**10-1**]
-repeat CXR in [**4-21**] weeks
-monitor renal function with repeat chem-10 in 1 week

Medications on Admission:
Lasix 80mg qd
Simvastatin 40 mg qhs
KCl
MVI
Vit B12 SC q month
donepezil 5mg qhs
ASA 81mg qday


Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Donepezil 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).

3. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig:
One (1) Tab Sust.Rel. Particle/Crystal PO once a day.
5. Lasix 80 mg Tablet Sig: One (1) Tablet PO once a day.
6. Multiple Vitamin     Tablet Sig: One (1) Tablet PO once a
day.
7. Vitamin B12-Vitamin B1 100-1 mg/mL Solution Sig: One (1)
Injection Intramuscular once a month.
8. Memantine 5 mg Tablet Sig: Two (2) Tablet PO bid ().
9. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 3 days.
Disp:*3 Tablet(s)* Refills:*0*
10. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 3 days.
Disp:*9 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 2255**] [**Name (NI) 2256**]

Discharge Diagnosis:
Primary:
Congestive Heart Failure, Diastolic, Acute exacerbation
Likely Pneumonia (aspiration)
Cellulitis of Right lower extremity
Acute Renal Failure (in setting of diuresis)
Secondary:
Coronary Artery Disease
Dementia, Alzheimer's Type
Osteoarthritis
B12 Deficiency

Discharge Condition:
Afebrile, vital signs stable (O2 sats 95-96% on RA).
Pertinent discharge Labs:
BUN-20, Cr-1.3
WBC-7.7

Discharge Instructions:
Please complete the course of antibiotics as prescribed (last
dose on [**10-9**]).  You should also take all your medications as
outlined in the provided medication list. Please arrange a
follow up appointment with your primary care doctor within 1
week.  You will need to have your chemistry panel (including
tests for your kidney function) drawn at that time.  You should
continue to take your lasix daily.  Please weigh yourself daily.
 If your weight increased by >3 lbs, please call your doctor.
You are being given a home suction machine which you can use for
your secretions.
.
Return to the emergency room or call your doctor if you have:
Fever
Shortness of Breath or Chest Pain

Followup Instructions:
Primary Care Doctor: Dr. [**Last Name (STitle) 34339**] (VA [**Hospital1 1474**]).  [**Telephone/Fax (1) 34340**].
Please call for follow up within 1 week and to have labs drawn.
Cardiology: Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **].  Please call your doctor at the VA
[**Hospital1 1474**] to arrange a follow up appointment within 2 weeks.
{"Unspecified septicemia,Cellulitis and abscess of leg, except foot,Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Atrial fibrillation,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Other B-complex deficiencies,Aortocoronary bypass status,Severe sepsis"}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: Change in Mental Status

PRESENT ILLNESS: 74 yo M w history of alzheimers dementia, CAD, noted to be
increasing restless and his usual daycare. Was also agitated and
combative. Upon nurses assesment, pupils noted to be rolled back
in his head, and patient noted to have shaking tremors of lower
extemities.  All events witnessed by pt's wife and daughter who
were at Day Care withthe patient. Temp taken at Day care
registered at 103.1.  BP 130/82.  Family denied loss of
continence.  No LOC, family states that they were able to
communicate with the patient during the shaking episode.
.

MEDICAL HISTORY: Dementia
CAD s/p CABG [**49**] yrs ago
Osteoarthritis
B 12 deficiency
H/O afib
h/o recent toe cellulits RLE tx'd with 14 days of PO Keflex.

MEDICATION ON ADMISSION: Lasix 80mg qd
Simvastatin 40 mg qhs
KCl
MVI
Vit B12 SC q month
donepezil 5mg qhs
ASA 81mg qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T 102.4R, T99.5 axillary, BP 94/62; HR 88; 99%RA
Gen: lethargic male, diaphoretic in bed
HEENT: dry MM. Perrla, EOMI, but has trouble following commands
CV: tachy. reg s1 and s2. 2/6 systolic murmur best audible at
RUSB
CHEST: CTAB. No rales, rhonchi wheezes
ABD: + BS. Soft, NT, ND, no HSM.
EXT: bilat LE edema, but RLE > LLE signifcantly.  warmth and
erythema from R dorsal surface all the up to the knee. no
palbable chords.  No [**Last Name (un) 5813**] sign elicited.
LLE: [**Name (NI) **] PT and DP
RLE: [**Name (NI) **] PT and DP
NEURO: not able to cooperate with neuro exam.  patient is
lethargic, but arousable, does not follow commands, but able to
respond to the family (this is off baseline, family states).
moves all 4 extremities (though not on command). no neck
stiffness

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Pt lives at home with his wife and homemakers. Advance dementia,
but pt is able to dress and toilet himself (including shaving
his face and body). lifetime non-smoker and non-drinker.
Baseline ambulatory and able to participate in daycare
activities 

### Response:
{"Unspecified septicemia,Cellulitis and abscess of leg, except foot,Acute on chronic diastolic heart failure,Acute kidney failure, unspecified,Pneumonitis due to inhalation of food or vomitus,Atrial fibrillation,Alzheimer's disease,Dementia in conditions classified elsewhere without behavioral disturbance,Other B-complex deficiencies,Aortocoronary bypass status,Severe sepsis"}
