I am a 64-yo female with longstanding PMH of hypertension (28 years), well controlled on meds for the most part. I was diagnosed with diabetes in 11/2010, having been intermittently symptomatic for at least 3 years prior. Since DX, A1c levels have trended down from 7.0 to current level of 5.8, taking metformin and with dietary changes. Chronic depression/anxiety/stress of 20+ years is also adequately controlled with meds, but has been subject to ongoing unemployment woes since 11/2009 and consequential financial problems. Over the past 2 years I have noticed initially subtle, now gradually progressive mental status changes such as loss of focus and concentration, cognitive deficits affecting thinking, reasoning, decision-making and memory , plus mild expressive and receptive dysphasia signs. I asked my FP/PCP to order a brain scan w/wo contrast. The results I received last week are as follows: 1. Scattered nonspecific punctate bilateral frontal, bilateral parietal and left subinsular white matter T2/FLAIR hyperintensities may represent chronic microvascular ischemic changes, described in the impression as supratentorial and age-appropriate. 2. Bilateral old lentiform nuclei lacunar infarcts, the extent of which was not described. Having been a medical transcriptionist for 30+ years, I ve read a bit about both findings, and am vaguely familiar with the functions of these cerebral regions and the described processes, but I have two questions. I am assuming that either or both conditions are contributing to the mental status changes....particularly the bilateral lacunar infarcts. I originally thought these symptoms were attributable to chronic depression/anxiety/stress and the unemployment/financial problems. In your opinion, am I over-reacting to this news by making that assumption? Also, in view of these newly diagnosed deficits, would it be beneficial for me to consult with a neuropsychiatrist? I am asking because I am planning to seek counseling/ therapy for these problems since I need to re-enter the workforce. I am wondering if and how these conditions change the therapeutic approach. Specifically, I believe tests to evaluate the degree of cognitive deficits is in order, as it would stand to reason they would impact the modalities used in a therapeutic treatment plan. Any insight you can offer would be greatly appreciated.