A 69-year-old woman comes to the office due to memory concerns. The patient first began having difficulties with her memory a year ago, and her symptoms have steadily worsened. She often forgets the content of conversations she has with her son and frequently walks to another room, only to forget what she went there to do. The patient lives alone and has no difficulty cooking, cleaning, or otherwise caring for herself. She manages her own finances. Medical history is significant for hypertension, hyperlipidemia, and type 2 diabetes mellitus. Temperature is 36.9 C (98.4 F), blood pressure is 132/83 mm Hg, pulse is 72/min, and respirations are 14/min. The patient is alert and oriented. Neurological examination reveals no focal deficits. She scores 22/30 on the Montreal Cognitive Assessment. Which of the following is the most likely diagnosis?

Question

A 69-year-old woman comes to the office due to memory concerns.  The patient first began having difficulties with her memory a year ago, and her symptoms have steadily worsened.  She often forgets the content of conversations she has with her son and frequently walks to another room, only to forget what she went there to do.  The patient lives alone and has no difficulty cooking, cleaning, or otherwise caring for herself.  She manages her own finances.  Medical history is significant for hypertension, hyperlipidemia, and type 2 diabetes mellitus.  Temperature is 36.9 C (98.4 F), blood pressure is 132/83 mm Hg, pulse is 72/min, and respirations are 14/min.  The patient is alert and oriented.  Neurological examination reveals no focal deficits.  She scores 22/30 on the Montreal Cognitive Assessment.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

11ec160b_362f_8d0f_9249_fdc1f2f68c37_MD0001_00 This patient's mild memory impairment, abnormal Montreal Cognitive Assessment score (<26/30) and ability to function independently are consistent with mild cognitive impairment, also known as mild neurocognitive disorder. MCI is diagnosed when there is objective evidence of cognitive deficits that do not interfere with activities of daily living (ADLs) (eg, bathing, preparing meals, managing finances). In contrast, a diagnosis of dementia, also known as major neurocognitive disorder, requires the presence of progressive cognitive deficits that impair ADLs. MCI is common in older age, with >10% of patients age >70 meeting criteria. Patients with subjective memory concerns should be evaluated objectively through cognitive testing because certain memory issues (eg, difficulty remembering names, decreased processing speed) may represent normative age-related cognitive changes. When evaluating for MCI, it is important to rule out reversible causes of cognitive impairment such as depression-related cognitive impairment, hypothyroidism, vitamin B₁₂ deficiency, impaired sleep (eg, obstructive sleep apnea), and adverse effects of pharmacotherapy (eg, benzodiazepines). (Choices A, C, and F) This patient does not meet criteria for dementia (ie, progressive cognitive impairment that impairs ADLs). Alzheimer disease presents with early and prominent memory impairment. Frontotemporal dementia presents with personality and behavioral changes. Vascular dementia is characterized by focal neurological deficits and evidence of cerebrovascular disease on imaging. (Choice B) Although depression may be associated with reversible cognitive impairment, this patient does not meet criteria for major depressive disorder. (Choice E) Although mild memory issues may be a part of normal aging (eg, difficulty remembering names, decreased processing speed), this patient's objective evidence of cognitive impairment on formal cognitive testing is not normal and requires further evaluation. Educational objective: Mild cognitive impairment is diagnosed when cognitive decline is present but activities of daily living (eg, bathing, preparing meals, managing finances) are preserved. In contrast, dementia is diagnosed when cognitive decline interferes with activities of daily living.

A 69-Year-Old Woman Comes to the Office Due to Memory