A 76-Year-Old Woman Comes to the Office for a Routine

A 76-year-old woman comes to the office for a routine checkup.  Her medical history is significant for hypertension, type 2 diabetes mellitus, and hypothyroidism that are treated with oral agents.  The patient had a stroke a year ago and has mild residual weakness in the right arm.  Otherwise, she has no physical symptoms but is concerned about becoming more forgetful, especially because her mother died of Alzheimer disease.  She says, "Sometimes I can't remember people's names, and occasionally during conversations, I can't seem to find the right word."  The patient is widowed and lives alone.  She drives herself to the grocery store weekly and manages her own finances.  She describes her mood as "just okay," misses her husband, and regrets that she lives far from her children and grandchildren.  The patient plays cards with her close friends regularly and is looking forward to a trip to visit her family.  Her appetite is good, but she falls asleep earlier in the evening than before, awakening earlier in the morning and having less energy during the day.  Blood pressure is 135/76 mm Hg and pulse is 65/min.  Finger-stick glucose is 94 mg/dL and TSH is 2.4 µU/mL.  She scores 26/30 on the Montreal Cognitive Assessment.  Which of the following is the most likely diagnosis in this patient?

A) Alzheimer disease
B) Depression-related cognitive impairment
C) Hypothyroid-induced cognitive impairment
D) Mild cognitive impairment
E) Normal aging
F) Vascular dementia

Correct Answer:

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