Question

A 58-year-old woman presents with progressive forgetfulness, difficulty managing finances and getting lost in familiar places over 2 years. Screening with the Montreal Cognitive Assessment is 20/30. What is the most appropriate initial management step?

Accepted Answer

Arrange a comprehensive evaluation including history from an informant, physical examination, laboratory tests and neuroimaging to assess for dementia and reversible causes.

Answer

Reassure her that this is normal ageing and provide no further workup.

Answer

Start an antipsychotic medication for behavioural control.

Answer

Advise her to stop all activities including driving immediately without assessment.

Answer

Treat empirically with high-dose vitamin B12 injections only.

Practice question

A 58-year-old woman presents with progressive forgetfulness, difficulty managing finances and getting lost in familiar places over 2 years. Screening with the Montreal Cognitive Assessment is 20/30. What is the most appropriate initial management step?