Skill Checkup: A 62-Year-Old Woman Who Is Forgetful and Has Difficulties Navigating Activities

Jasvinder P. Chawla, MD, MBA


August 28, 2023

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

A 62-year-old woman in the United States presents to her primary care physician complaining of frustration with herself for being forgetful. "I'm getting old," she jokes to her physician. Her 35-year-old daughter accompanied her to her appointment and confirmed that in recent months, her mother has forgotten the names and birthdays of various family members and sometimes has trouble navigating activities that she has always done, such as dialing the phone or preparing her favorite recipe. Things seem to take her much longer than they used to, and she often struggles to find words for familiar objects in conversation. She has also missed family gatherings on two occasions after not remembering that she was invited and became disoriented and unable to find her way home from the grocery store. Both claim these events do not occur with any regularity but have happened multiple times over the past six months. This has caused the patient significant frustration and an increase in baseline anxiety. Her overall physical and cognitive functions are good. She lives alone and is able to care for herself as well as manage her affairs without assistance.

Physical exam reveals nothing remarkable. Body mass index (BMI) is 21 kg/m2; resting heart rate is 70 bpm; blood pressure is 120/80 mm/Hg; pulse rate is 84 bpm; and O2 saturation level is 97% on room air. Heart, lung, and breath sounds are normal on auscultation; liver and spleen are normal on palpation; and there is no generalized lymphadenopathy. She rarely consumes alcohol. The patient has a history of atrial fibrillation (AF) and hypertension that was diagnosed 10 years ago that is pharmacologically well controlled. She is currently being treated with enalapril 40 mg each day orally (PO Q day) and rivaroxaban 20 mg PO Q day. She has a negative history for clinical stroke and has no other comorbidities. Laboratory tests are within the normal range.


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