Walter B.

Annual CaringAI Listen screen completed Jul 22, 2026, seven minutes ten seconds. MyCog total 28 of 30, unchanged from the July 2025 baseline. Delayed recall three of three. PHQ-9 three. GAD-7 two. All IADLs independent. He is still working part time doing the books for his son's contracting business, which he offered as evidence that nothing is wrong, and on the numbers he is right.

He raised the complaint himself two years ago after his brother's diagnosis, and it has been a worry rather than a finding ever since. CPAP adherence pulled from the device report at 91 percent of nights over ninety days, up from 62 percent at the last screen, and his sleep is the one thing that genuinely changed this year. Clarity read all four domains flat and inside band, with the small timing improvement tracking the CPAP adherence rather than anything cognitive.

Plan: continue annual screening, next due July 2027. No imaging, no neuropsychology, no change to the care plan. Reassured him directly that both the score and the voice read are stable, which is worth saying out loud to a patient who is watching his brother decline. Continue CPAP, continue diabetes management with his endocrinologist.

No neuroimaging obtained or indicated. Screening scores and the voice read are both stable across two annual cycles in a patient with normal delayed recall, full functional independence and no focal neurological findings on his last in office examination. Routine structural imaging in this setting adds cost and incidental findings rather than information.

Documented here so the absence is a decision on the record rather than a gap. Threshold for MRI brain would be any drop in delayed recall, a rising Clarity trend across two consecutive screens, or a new functional complaint from the patient or his family.