Visual loss and dementia

A 75-year-old tenured college professor is brought in by his wife with a chief complaint of inability to read. The wife is already physically disabled and in a wheelchair and relies on her husband for many of her activities of daily living. He has been to five ophthalmologists already and been given a dozen pair of new glasses which the wife has brought to the doctor in a brown paper bag. She states that he used to do the checkbook for the household but now cannot seem to balance the account properly. He has gotten lost in the grocery store three times this year and she would not drive with him anymore because she states that he can't see the road signs. The patient is well groomed, articulate, and soft spoken. He makes several substitution errors during conversation however but quickly corrects himself (e.g., he stated that he drove his car to the airport today when he meant to say that he drove to the office visit). His students have been complaining to the dean that he rambles in lecture and often seems disorganized in class but he has full tenure and is the Chair of his department so no one wants to tell him about his problems.