More than a year before Gary Ott was re-elected county recorder in 2014, a neurologist who examined him was unsure how Ott could function at work, given the progressive mental decline he’d experienced by that point.

The doctor, Trevor J. Squire, diagnosed Ott with dementia – specifically Alzheimer’s disease – after Ott struggled to repeat words read to him and showed signs of a disease that had begun advancing possibly three or four years before.

The testimony, in a case that a 3rd District judge decided to keep open to journalists and the public, was the first unvarnished view of Ott’s condition during a time in elected office when his staff repeatedly denied any problem with his mental health.

One former staffer, Karmen Sanone, who was also Ott’s former fiancée, is fighting the longtime county recorder’s siblings in court for the power to care for him and make all his financial and life decisions for him. Ott has stage four Alzheimer’s disease, attorneys said in a court hearing Thursday.

During the hearing, which Judge Bruce Lubeck considered closing but kept open after an attorney representing The Tribune intervened, the family’s attorney sought to lay out a timeline of events during which physicians, employees and friends say they witnessed a clear decline in Ott’s ability to hold conversations and conduct business.

Squire said he gave an examination to Ott in October 2013 that is designed to determine mental cognition. Ott received a 7 out of 30, Squire said. Anything under 26 is considered “possibly abnormal,” and the lower the score, “the more likely the cognitive impairment is.”

The finding affirmed what Charles Richardson, Ott’s family physician, had suspected that same year: Ott was likely suffering from a form of dementia that as of Thursday had progressed to severe Alzheimer’s disease.

Nevertheless, Ott, a Republican, remained in office nearly four more years following his initial diagnosis, including winning re-election in 2014. His top staff repeatedly denied he was suffering from a mental illness. They said they were writing emails for him but only on his behalf, writing what he told them to write and never misrepresenting his direction.

But Eric Keller, a longtime friend and husband of Ott’s former chief deputy, said he noticed drastic changes in behavior even before Ott’s unsuccessful run for county mayor during the 2012 election.

“Gary was never a great public speaker, but he was always proficient at it,” Keller said. “But on the day he announced he was running for mayor, he was stumbling through that.”

Others saw the same problems.

Rebecca Lancaster, who works in the county treasurer’s office, said she approached Salt Lake County District Attorney Sim Gill and the county’s human resources department with similar concerns in 2012. She was told there was little that could be done.

Squire and Richardson said when they saw Ott in 2013, he’d had cognitive issues in every domain, particularly with his language.

Ott struggled repeating his oath of office, even his name, during his January 2015 swearing-in to a new term by Salt Lake County Clerk Sherrie Swensen, according to a video of the event.

Before that time, Richardson said Thursday, Ott couldn’t read complex documents. He had difficulty remembering words during conversations, only to recall them later on.

When Ott visited Richardson, the family physician, between nine and 12 times from August 2013 through January 2016, he would frequently be with Sanone.

The visit when he first diagnosed Ott with dementia was so long ago, Richardson said, that he couldn’t recall with any certainty whether he discussed the condition with Sanone in the room.

“But I would assume that I did,” he said, given his notes and the number of office visits the two made.

Sanone and her attorney are arguing Ott signed a document – called an advanced health care directive – in January 2015, assigning her as his guardian should he need one in the future. They say she took care of Ott during his cognitive decline and that he should be in her care, not his family’s.

But witnesses called by the family’s attorney, Mary Corporon, testified that by the time that document was signed, Ott wasn’t capable of making decisions about whether or not to sign forms.

By late 2013, “He would sign whatever you told him to sign,” said Tonya Keller, who worked for Ott for 12 years, including several as his chief deputy.

While the case is playing out before in court, Ott is in an undisclosed medical facility. He didn’t make an appearance Thursday and won’t Friday.

Ott was living with Sanone at her North Ogden farmhouse during his last years in office, according to court testimony and previous interviews. Loan payments on Ott’s Salt Lake County home equity loan and utility bills went unpaid for months, The Tribune found. He had interactions with police on at least three occasions from early 2016 through his negotiated resignation from office in August.

When Salt Lake County Mayor Ben McAdams called for Ott’s resignation in June, Sanone denied Ott had a mental illness, but declined to discuss specifics.

“I’m not free to discuss his health,” she said. “That’s something that you need to talk to him and his doctors about. That’s protected by law.”

During his final interviews, Ott also denied he had dementia. Sanone and Ott’s deputy recorder, Julie Dole — who effectively ran the office during Ott’s final three years — referred to a case of shingles that they said may have caused irregularities the public was beginning to notice.

Dole also explained away Ott’s frequent absences from work as part of his hands-off management style. She is listed as a witness who may testify when the case continues Friday.

(Michael Mangum | Special to the Tribune) Julie Dole applauds for the remaining candidates after learning she was eliminated in the first round of voting during the recorder election at the county republican Central Committee Meeting at Jordan High School in Sandy, UT on Thursday, August 17, 2017.

In September 2014, Eric Keller said he ran into Ott at a restaurant in downtown Salt Lake City. Ott was with Sanone and Dole, who was running his re-election campaign for recorder.

He approached Ott, Keller said, and “Karmen grabbed him by the arm and pulled him away ... out to her car and they’re out of there.”

Dole was hired by Ott just about the time he filed for re-election in early 2014 and she was listed as the manager of his campaign. Sanone was hired two days after his election victory, at the directive of Dole, who said she was acting on behalf of Ott.