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The fact that she has a lot on her plate does not rule out the other things. Hasn't she always had a lot on her plate? Actually, if there is someting seriously wrong, you will know soon enough because the symptoms will keep getting worse. But that does not mean she shouldn't be checked out now.

The fact that she is forgetting things would concern me more than the smoking. Does she repeat herself in conversations? I would be worried about dementia.