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You have been the PCP for  MA, a 72 year old female, for the…

You have been the PCP for  MA, a 72 year old female, for the past 3 years.  Her 2 daughters brought her to clinic today.  MA currently lives in her own home alone and her daughters live in the same town.  Her daughters are concerned because MA has been more forgetful and recently had trouble driving home from church.  She got lost and had to stop several blocks from home to ask how to get to her address, which she did remember. They have noticed these changes for the past year or so, and more often lately.  She denies  headaches, chest pain, palpitations. lightheadedness, SOB or loss of consciousness.  MA states that she has been eating well, sleeping well, she enjoys a glass of wine with friends every other week or so. Her husband of 46 years died 4 years ago.  She has stayed active in her community and in her church.  She has generally been in good health and has regular health care, follow up.  She misses her husband but has generally been in good spirits.  PMH:  Stable hypothyroid – diagnosed 8 years ago Complete PE:  results within normal limits Medications:  Levothyroxine 50 mcg daily, no other medications, herbs or supplements Labs (2 days ago):  CBC, CMP, TSH, vitamin B12, folate:  normal.  Lipids, mildly elevated (you and MA have chosen not to treat with med) EKG:  NSR, no ectopy You are concerned about the potential for early dementia. You review the chart, talk to the patient and family, and consider the following in your diagnosis: