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A 65-Year-Old Woman Comes to the Office Due to Deteriorating

question 421

Multiple Choice

A 65-year-old woman comes to the office due to deteriorating memory. She used to pride herself on her sharp memory and is very concerned about its loss, saying, "Over the last 6 months I have been forgetting the most trivial things." The patient has had to delegate tasks such as household chores and cooking to her husband because of her poor memory and "cloudy thinking." "I have been feeling useless and worthless since retiring last year. Now I just watch TV all day and barely have enough energy to eat. I haven't felt like gardening in over a year-I used to love it!" Both the patient's mother and father died of complications of Alzheimer disease. She's lost 5 kg (11 lb) over the last 2 months but her physical examination is within normal limits. On testing with the Montreal Cognitive Assessment, she scores 24/30 (normal ≥26) with deficits in delayed recall and attention. Laboratory results, including thyroid function, are unremarkable. MRI of the head is normal. Which of the following is the best next step in management of this patient?

Definitions:

Peer Review

The evaluation of work or performance by one or more people with similar competences as the producers of the work, often used in academia and professional fields.

Nonunion Grievance Processes

Procedures allowing employees not affiliated with a union to address complaints or disputes in the workplace.

Grievance Filing Rates

The frequency at which employees file formal complaints (grievances) against their employers, usually related to contract or work condition violations.

Past Practice

A term used in labor relations to refer to a customary practice that, over time, has become an accepted way of doing things despite not being formally written into a contract.