Confused 73 yr Old
harry206 - 05-05-09 02:54

A 73-year-old widow is brought by her daughter for an examination. She lives alone in an apartment and continues to drive. Her daughter reports that her mother began having a gradually worsening difficulty with her memory two years ago. She is able to perform most of the activities of daily living and cooks for herself, but she has left burners on for no reason. She has also called her daughter on a number of occasions from a pay telephone while driving in the local community, stating that she was lost. Two days ago, she withdrew her entire ,000 savings account, arguing with the bank teller that she needed the entire amount in .00 bills. Her daughter also remarks that her personality has become more agitated and aggressive. Her past medical history and review of systems reveal hypertension, which is being treated with an ACE inhibitor. Her family history is negative for dementia. On physical examination, she is alert, cooperative, normotensive, and is not depressed. Her Mini-Mental State Examination (MMSE) score is 22. She recalled 1 of 3 objects after 5 minutes. She is unable to draw a clock and states, "Who pays attention to the date? I"m retired." She is disoriented to time and place. Her neurologic examination is otherwise normal, with no lateralizing signs and no extrapyramidal symptoms. Her gait is normal. What is the next best step in the management of this patient?