Dr Timothy Chan report

Dr Timothy Chan report + Sejin Bone density

Acacia Fiori Geriatrics 

09/05/2025 

Jason Tan, 

Adelaide Internal Medicine 194 Payneham Road EVANDALE S069 0468 934 027 

Re: Mrs Chungsoon Pak 19/08/1947 

43 Riverbank Cirenit CAMPBELLTOWN 5074 

Acacia-Flori Geriatrics 230 St. Bernards Road, Hectorville,SA 5073 

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Profile 

Mrs. Pak is a woman originally from South Korea who has been living In Australia for approximately 33 years after previously living in Canada for 15 years. She worked as a high school teacher of Korean and Japanese languages until retirement approximately 10 years ago. She continues to teach one class of Korean to English-speaking adults on Saturdays. She was also the principal of a Korean ethnic school for about 20 years until retirement 10 years ago. She currently performs an accountancy role for the current principal on a volunteer basis. 

Past medical history 

REM sleep behaviour disorder (15-year history) 

- Periodic limb movement disorder 

- Constipation 

- Hyperlipidaemia 

- Lactose intolerance 

- Osteopenia 

Medication list; 

- Pramipexole 250 micrograms at night 

- Clonazepam 0.5 mg, one to two tablets at night (most nights) 

- Multivitamin tablet (not regular) 

- Magnesium supplement (not regular) 

- Atorvastatin 10 mg once dally 

Alcohol history: no regular ETOH Smoking history: Nil 

Allergies: NKDA 

Cognition: 

• Mrs. Pak's husband reports that she has been showing cognitive changes, particularly over the last year, with increased forgetfulness and difficulty with planning and sequencing tasks. 
• She has difficulty with computer skills that she previously possessed, particularly using Excel and Microsoft Office. 
• She has difficulty keeping track of messages and emails, with many unread communications. 
• Her husband has noted deterioration in her English and Japanese language skills, though her native Korean remains intact. 
• She has more difficulty following English-language films and dramas. 
• Short-term memory appears to be more affected than long-term memory. 
• Her husband reports she has become more emotionally labile in the last couple of years, becoming more early upset and argumentative. 
• She occasionally senses a presence in the house, feeling as though her son or mother-in-law is present when they are not, though she recognises these sensations are not real No visual or auditory hallucinations reported. 

Mobility and falls: 

Mrs. Pak is physically independent with mobility and does not use any walking aids. She has had a couple of falls in the last 12 months, including one at a swimming pool where she scraped her knee. 

Weight and appetite 

Nil significant issues reported 

Sleep: 

Mrs. Pak bas had REM sleep behaviour disorder for approximately 15 years, initially presenting with talling, snoring, kicking during sleep, sleepwalking, and vivid nightmares. She has occasionally sustained injuries from bumping into furniture during sleep episodes. She underwent a sleep study and was diagnosed with REM sleep behaviour disorder. She is currently managed by a sleep physician, Dr. Dang. Her sleep symptoms are now better controlled with medication but have not completely resolved. 

Mood: 

Her husband reports she has become more emotionally labile in the last couple of years, becoming more easily upset and argumentative. 

Social history: 

Mrs. Pak lives with her husband. She continues to teach one class of Korean to English-speaking adults on Saturdays. She also performs an accountancy role for the current principal of a Korean ethnic school on a volunteer basis, which she is increasingly reliant on her husband to complete. 

Advance Care directives: 

ACD not sighted today, to review at next appointment 

Examination: 

Alert and oriented to place, date, and day of the week. 

No parkinsonlan features noted: no rígidity, tremor, or masked facies. 

Normal gait, no mobility issues observed. 

Investigations: 

- Mini-Mental State Examination score of 24/30 on 04/03/2025 

- Frontal Assessment Battery score of 11/18 

- MOCA 17/30 (confounding issue being language, as though fluent English is not her primary language) 

- GDS 2/15 

- PET scan reportedly shows changes consistent with Lewy body dementia 

Clinical Assessment: 

Mrs. Pak presents with probable early Lewy body dementia based on her 15-year history of 

1. REM sleep behaviour disorder diagnosed with polysomnogram. 

2. Supportive features including hyposmis and loss of taste sensation of more than 10 years duration, with constipation and minor (presence) hallucinations, executive function difficulties (loss of computer skills, difficulty with planning and sequencing), and cognitive testing showing frontal-executive impairment. 

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3. Imaging biomarker with PET CT scan findings consistent with Lewy body dementia. 

There is a notable absence of significant parkinsonian motor features at this stage. 

Her cognitive changes are more pronounced in the domains of executive function and planning rather than memory 

Management Plan: 

·Provided education about early Lewy body dementia 

· Discussed importance of maintaining cognitive and social activities 

- Recommended completing advance care directives while cognitive capacity remains intact 

- Provided information about Dementia Australia resources 

- Driving; advised to continue current practice of limiting driving to familiar routes within 5km of home and daytime only 

- Consider formal driving assessment at next visit 

- Consider cholinesterase inhibitor therapy (rivastigmine) at next visit if symptoms progress 

I have arranged for Mrs Pak to be reviewed again in 3 months time. 

As I will be moving practices, she has been informed that she will most likely be seeing one of my colleagues at the next review, 

Kind regards 

Dr Timothy Chan 434181QL 

Geriatric Consultant, FRACP Acute and General Medicine 

Graduate Chapter of Perioperative Medicine (GCHPOM) 

Carer PAK, Sejin 43 Riverbank Circuit, Campbelltown SA. 5074 

Birthdate: 20/10/1948 Sex: M