An 85-Year-Old Man Comes to the Office for a Routine

An 85-year-old man comes to the office for a routine health evaluation.  The patient lives independently but is accompanied by his daughter who does his grocery shopping and visits him weekly.  The daughter is concerned that her father seems increasingly withdrawn and forgetful over the past year.  She reports that he does not socialize with his neighborhood friends as much as he used to and calls her less frequently.  "When we do speak, he often seems to forget what I just told him and repeats the same question that I've just answered."  The patient admits that he sometimes forgets names but attributes this to "old age."  He denies any changes in mood, sleep, or appetite.  Medical history includes hypertension and osteoarthritis of the knees.  Current medications include hydrochlorothiazide and ibuprofen.  Vital signs are within normal limits, and physical examination is unremarkable.  The patient is pleasant and cooperative and speaks loudly.  Montreal Cognitive Assessment score is 26/30.  Which of the following is the most appropriate next step in management of this patient?

A) Antidepressant trial
B) Hearing evaluation
C) Home geriatric assessment
D) MRI scan of the brain
E) Reassurance that this is normal aging
F) Thyroid function testing

Correct Answer:

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