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

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?

A) Reassure patient that these are expected age-related memory changes
B) Recommend memory training and vitamin E
C) Start amantadine pharmacotherapy
D) Start donepezil pharmacotherapy
E) Start escitalopram pharmacotherapy
F) Start memantine pharmacotherapy