A 74-year-old woman comes to the office for a routine checkup. She has had difficulty with her memory that has worsened over the past year. She sometimes forgets important appointments, including doctors' appointments. The patient often forgets to take her daily pills. It has also become difficult for her to remember the names of new people she meets, and she often has to write them down. The patient drives, shops, and pays her bills independently. She admits that she has had bouts of loneliness since her husband died 2 years ago; however, she still enjoys socializing with friends when she has the energy. The patient has hypertension, hyperlipidemia, gastroesophageal reflux disease, and left knee osteoarthritis. Her mother died of a stroke, and her father died of Alzheimer disease.
The patient's blood pressure is 132/78 mm Hg and pulse is 76/min. BMI is 29 kg/m². Neurological examination shows no focal deficits. She scores a 25/30 on the Montreal Cognitive Assessment.
Which of the following is the most likely diagnosis for this patient?

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11ec193a_987c_b628_853d_fb2c0c290555_MD0002_00 This patient's presentation is consistent with mild cognitive impairment (MCI), also known as mild neurocognitive disorder. MCI is characterized by cognitive impairment that does not meet criteria for dementia (ie, major neurocognitive disorder) but is more severe than the mild deficits found in normal aging (Choice E). Patients with MCI have noticeable cognitive impairments but are generally able to compensate for their deficits (eg, written reminders) and function independently. One of the most widely used tools to assess for MCI and dementia is the Montreal Cognitive Assessment (MoCA). Scores of <26 are highly sensitive for MCI or dementia; however, the MoCA possesses only moderate specificity. MCI is found in 2 subtypes: amnestic (ie, primarily memory impairment) and nonamnestic MCI. Amnestic MCI is twice as prevalent as nonamnestic forms; amnestic MCI more frequently evolves into Alzheimer disease. (Choices A and B) The diagnosis of dementia requires evidence of progressive cognitive decline accompanied by functional impairment in activities of daily living (ADLs); this patient demonstrates independence with ADLs and so does not meet the criteria for dementia. Alzheimer disease frequently presents with prominent early amnestic symptoms whereas dementia with Lewy bodies may present with fluctuating attention/arousal, visual hallucinations, and REM sleep behavior disorder. (Choice C) Although major depressive disorder frequently accompanies cognitive impairment in elderly patients, this patient lacks key features of this disorder (eg, anhedonia, decreased interest in activities). Educational objective: Mild cognitive impairment (MCI) is characterized by impaired cognition with preserved functioning and independence of activities of daily living. Patients with the amnestic MCI subtype are at increased risk for developing dementia. __________ References: Prevalence of DSM-5 mild neurocognitive disorder in dementia-free older adults: results of the population-based LIFE-adult-study. (http://www.ncbi.nlm.nih.gov/pubmed/27618647) Is mild cognitive impairment a precursor of Alzheimer's disease? short review. (http://www.ncbi.nlm.nih.gov/pubmed/26841152) Mild cognitive impairment and mild dementia: a clinical perspective. (http://www.ncbi.nlm.nih.gov/pubmed/25282431)

A 74-Year-Old Woman Comes to the Office for a Routine