A 78-Year-Old Woman Is Brought to the Emergency Department by Her

A 78-year-old woman is brought to the emergency department by her daughter, who is concerned about the patient's increasing forgetfulness and ability to live on her own.  The daughter says, "Over the past month, my mother seems to ask me the same questions over and over.  When I visited last week, she seemed slowed down overall and couldn't remember if she had taken a shower that day.  She has also stopped shopping for groceries and cooking for herself, although she did eat all the meals that I prepared."  The patient takes medications for type 2 diabetes mellitus, hypertension, and urinary incontinence.  Over the past several months, she has had difficulty sleeping due to a burning sensation in her feet from diabetic neuropathy.  After recently discussing these symptoms with her primary care physician, the patient was prescribed a new medication that provided significant relief.  Blood pressure is 138/86 mm Hg and pulse is 84/min and regular.  The lungs are clear on auscultation and heart sounds are normal.  The abdomen is soft and nontender.  The patient's gait is slow, but there are no focal neurologic deficits.  Montreal Cognitive Assessment score is 24/30 (normal: ≥26) with deficits in orientation, attention, and recall.  Which of the following is the most appropriate next step in management of this patient?

A) Arrange placement in an assisted living facility
B) Begin donepezil and home health care
C) Evaluate with the Geriatric Depression Scale
D) Obtain an MRI of the brain with gadolinium
E) Perform hearing and vision screening
F) Review the patient's current medications