Skill Checkup: A 71-Year-Old Woman With Signs of Self-Reported Cognitive Impairment and Primarily Short-Term Memory Loss

Shaheen E. Lakhan, MD, PhD, MS, MEd


January 31, 2023

Based on the patient's history, she is likely in the mild AD stage; when the disease begins to affect the cerebral cortex, memory loss becomes more noticeable, and impairment of other cognitive abilities emerges. The clinical diagnosis of AD is usually made at this point in the disease course. AD may be classified by evaluating cognitive impairment with tools such as the Mini-Mental State Examination, Montreal Cognitive Assessment, or Clinical Dementia Rating.

Cognitive features of early AD include memory loss, mild anomic aphasia, and visuospatial dysfunction. Signs that characterize mild stage disease include taking longer to accomplish daily tasks, trouble handling money and paying bills, increased anxiety, confusion about the location of familiar places, compromised judgment, and loss of spontaneity and sense of initiative.

As this patient's disease course progresses, behavioral problems (such as wandering and agitation) may develop. Signs that characterize moderate stage disease include shortened attention span; difficulty with language; repetitive statements or movement; occasional muscle twitches; problems with reading and writing; difficulty recognizing friends and family members; difficulty organizing thoughts; hallucinations, delusions, and suspiciousness or paranoia; loss of impulse control; and perceptual-motor issues.


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