Clinical Pearl of the Month – Mild Cognitive Impairment

Kelly SeagravesClinical Pearls, Medical News

Clinical Pearl of the Month

Today’s Clinical Pearl of the Month question comes from the desk of Med-Challenger Family Medicine Editor, Gerard Kiernan, MD, FAAFP, FHM.

Test your skills with this review question.

Review Question

A 73-year-old woman complains of worsening memory, and reports that her husband and adult children have been worried about her recall as well. She denies depression. Her medical history includes hypertension and hyperlipidemia and she is taking lisinopril and simvastatin.

Her physical examination is unremarkable. She does not have any focal neurologic deficits and she has no word-finding difficulty. Laboratory evaluation, including TSH and B12 levels, is normal. On cognitive testing, she scores 25/30 on the Montreal Cognitive Assessment (normal is 26 or higher). Neuroimaging by MRI is normal. She is diagnosed with mild cognitive impairment (MCI).

She returns to the clinic with her husband, son, and daughter, looking for recommendations on how to avoid further cognitive decline or dementia.

Question

Of the following, which has been shown to be helpful in slowing or avoiding the progression from MCI to dementia?

Answer Options:

Rivastigmine

Donepezil

Aerobic exercise

Gingko biloba

Answer Explanation & References:


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About the Author:

Gerard Kiernan, MD, FAAFP, FHM is a Dartmouth-Hitchcock Clinic hospitalist in Keene, NH. He attended the University of Rochester School of Medicine and Dentistry, followed by a Family Medicine residency at the University of Wisconsin, Madison, where he was a chief resident. Dr. Kiernan is a Lean Six Sigma Greenbelt and has led hospital medicine quality improvement efforts. He is a fellow of both the American Academy of Family Physicians and the Society of Hospital Medicine. He has achieved the Recognition of Focused Practice in Hospital Medicine offered through the AAFP and ABIM via their joint examination pathway.

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