A 62-year-old woman presents with worsening agitation as wel…

A 62-year-old woman presents with worsening agitation as well as frequent mood swings. A history of present illness obtained from her daughter reveals she has been developing progressive forgetfulness and has frequently been getting lost on her way back home while driving familiar routes. She has also experienced brief but frequent periods of confusion, characterized by nonsensical speech. Other reported symptoms include excessive daytime sleepiness as well as difficulty sleeping at night. Over the past 12 months, the patient has had increasing visual hallucinations and paranoid behavior accompanied by agitation and restlessness. Her medical history is significant for mild depression, and her only medication is sertraline. Her vital signs are within normal limits. Her general physical exam findings are unremarkable. The neurologic examination reveals an agitated and restless female with masked facies, a soft voice, postural instability, and a slow gait. She scored 24/30 on the Mini-Mental State Examination, where she lost points on orientation to time and place, delayed recall, and figure drawing. A depression screen is negative for depressed mood. The patient receives haloperidol in the emergency department to treat the agitation, which results in worsening of her symptoms with associated limb and neck stiffness. Which of the following is the most likely diagnosis?

A 65-year-old woman presented to the office, accompanied by…

A 65-year-old woman presented to the office, accompanied by her husband, with complaints of forgetfulness, reduced energy, and a decreased appetite for several months. She appeared distressed and said, “I feel terrible when I am not able to remember things. I was never like this before.” On mental status examination, she had a sad affect, and the mini-mental status exam showed a score of 25/30 (a normal score is more than 24). Still, she refused to reply to some questions and needed to be persuaded continuously to participate in the examination, as most of her answers were “I don’t know.” What is the best next step in the management of this patient?