 On general exam, she is an elderly woman with now marked aphasia, which per her daughter waxes and wanes, was more pronounced and she nods her head up and down when she says the word, no, and conversely, she nods her head side-to-side when she uses the word yes with some discordance in her head gestures with vocalization. 
On general exam , she is an elderly woman with now marked aphasia , which per her daughter waxes and wanes , was more pronounced and she nods her head up and down when she says the word , no , and conversely , she nods her head side - to - side when she uses the word yes with some discordance in her head gestures with vocalization .