Progressive memory concerns
Hello everyone,
Today I’m presenting the case of Mrs. Simmons, an 84-year-old woman brought in by her daughter due to Progressive memory concerns, apathy, poor self-care, and increasing social withdrawal.
Mrs. Simmons reports sleeping more than usual, decreased appetite, and appears emotionally flat. Her daughter is particularly concerned about possible depression or cognitive decline.
B – Background
Mrs. Simmons has a history of hypertension, osteoarthritis, and bilateral hearing loss for which she uses hearing aids.
She also had a prior episode of depression following her husband’s death, which resolved with treatment about a year later.
Her current medications include:
Lisinopril 12.5 mg daily
Vitamin D 2000 IU daily
Ibuprofen 400 mg, as needed
Voltaren gel, daily
She has a sulfa allergy, causing nausea and vomiting.
Socially, she is widowed, lives alone, has limited support—with only her daughter nearby—and is a retired office worker. She does not consume alcohol.
A – Assessment
Her screening results are as follows:
Geriatric Depression Scale score: 10 out of 15 — which is consistent with significant depression
MoCA score: 27 out of 30 — indicating mild cognitive deficits, especially in attention and orientation, but not consistent with dementia
On physical exam, she shows psychomotor slowing, a flat affect, and reports changes in sleep and appetite, along with clear social withdrawal.
All labs including CBC, CMP, TSH, B12, and Folate are within normal limits.
Our working impression is:
Late-life major depressive disorder, possibly with mild cognitive impairment related to depression. There is no active suicidal ideation or psychosis.
R – Recommendation
To support Mrs. Simmons, I recommend the following:
Initiate pharmacologic treatment:
Start Sertraline 25 mg daily, with plans to titrate based on effect and tolerability.
Refer to Geriatric Psychiatry:
For a full mental health evaluation and possible addition of psychotherapy.
Reassess cognitive function:
Repeat the MoCA in 8 to 12 weeks, once her mood is stabilized, to determine whether the cognitive symptoms are secondary to depression.
Home health referral:
To assess safety, assist with ADLs, and support homemaking and bill management.
Engage community resources:
Refer to Meals on Wheels, local senior centers, or adult day programs to improve nutrition and promote social engagement.
Support for family/caregivers:
Offer education and emotional support to her daughter, and consider case management if caregiver burden is high.
Follow-up:
Schedule follow-up in 2 to 4 weeks to assess medication response, side effects, and functional progress.
Thank you.
This case highlights the importance of recognizing late-life depression, which can often mimic or mask early cognitive decline. A comprehensive and compassionate approach, including both medical and social support, will be essential to Mrs. Simmons’s recovery and overall quality of life.
References:
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.
Yesavage, J. A., & Sheikh, J. I. (2023). Geriatric Depression Scale (GDS): Recent validation and clinical use. Journal of Geriatric Psychiatry and Neurology, 36(1), 45–52. https://doi.org/10.1177/08919887221139544
Nasreddine, Z. S., & Phillips, N. A. (2023). Montreal Cognitive Assessment (MoCA): Updated norms and applications in aging populations. Journal of the American Geriatrics Society, 71(3), 580–588. https://doi.org/10.1111/jgs.18117
National Institute on Aging. (2024). Depression and older adults. U.S. Department of Health & Human Services. https://www.nia.nih.gov/health/depression-and-older-adults
American Geriatrics Society. (2023). Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. https://geriatricscareonline.org
2)Situation
I am presenting Ms. Clara Simmons, a 74-year-old female, who was evaluated after expressing persistent low mood, loss of interest in activities, and feelings of helplessness. She also endorsed fears that something bad may happen, a sense of worthlessness, and hopelessness. It looks like she might be depressed because she got an 8 out of 15 on the short form of the Geriatric Depression Scale. She says she does not have severe confusion, hallucinations, or changes in how alert she is, all of which make delirium less possible (Marx et al., 2023).
Background
Ms. Simmons is a 74-year-old widowed woman who has lived alone since her husband\’s death three years ago. She has limited social support, as her adult children visit infrequently. She has osteoarthritis, high blood pressure, and high cholesterol in her medical history. She also had a hysterectomy when she was fifty. Lisinopril 10 mg once a day, atorvastatin 20 mg once a night, and acetaminophen as needed for joint pain are the medications the patient is taking. She has not been in a psychiatric hospital, but she says her depression has gotten worse over the past year, especially in the last few months. She does not smoke, drink, or use illegal drugs. On exam, she was alert, oriented, and hemodynamically stable. Cognitive screening was standard, with an MMSE score of 29/30 and a MoCA score of 26/30. Routine labs were unremarkable (Abdoli et al., 2021).
Assessment
According to my assessment, Ms. Simmons most certainly fits the criteria for major depressive disorder with a late onset and no psychotic symptoms. This conclusion is supported by her self-reported symptoms, which are consistent with clinically severe depression, and her GDS score of 8/15. Although dementia is one of the differential diagnoses taken into consideration, her cognitive scores and maintained memory contradict this. Additionally, Delirium is unlikely due to the chronic nature of her symptoms and absence of acute medical illness or fluctuating mental status. A grief reaction, Prolonged Grief Disorder (PGD), is also a consideration; however, since she lost a loved one several years ago and is still having symptoms that make it hard for her to function, depression is the more likely diagnosis (Resendes et al., 2022).
Recommendation
I recommend starting treatment with an SSRI, such as sertraline 25 mg daily, with gradual titration as tolerated, along with a referral for cognitive behavioral therapy (Lubsen et al., 2021). In order to lessen her sense of loneliness, I would also advise her to join a bereavement support group or a senior community activity. In terms of follow-up, I advise continuing to coordinate with her primary care physician for the management of her chronic diseases, and I intend to review her in four weeks to check treatment response and side effects. If her symptoms worsen or suicidal thoughts develop, I would seek urgent psychiatric consultation.
References
Abdoli, N., Salari, N., Darvishi, N., Jafarpour, S., Solaymani, M., Mohammadi, M., & Shohaimi, S. (2021). The global prevalence of major depressive disorder (MDD) among the elderly: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 132, 1067–1073. https://doi.org/10.1016/j.neubiorev.2021.10.041Links to an external site.
Lubsen, J., Landeck, J., & Stiles, M. (2021). Depression and grief in older women. In Springer eBooks (pp. 45–60). https://doi.org/10.1007/978-3-030-59058-1_4
Marx, W., Penninx, B. W. J. H., Solmi, M., Furukawa, T. A., Firth, J., Carvalho, A. F., & Berk, M. (2023). Major depressive disorder. Nature Reviews Disease Primers, 9(1). https://doi.org/10.1038/s41572-023-00454-1Links to an external site.
Resendes, N., Hammel, I., & Hogue, C. (2022). The 3 DS: Dementia, Delirium, and Depression in oral health. In Springer eBooks (pp. 161–175). https://doi.org/10.1007/978-3-030-85993-0_9
Instructions
Evaluate the clarity and organization of the SBAR presentation. Did the presenter effectively communicate the key points of the case? Was there extraneous, unrelated, or distracting, information present?
Assess the accuracy and completeness of the assessment. Were the differential diagnosis and clinical reasoning well-supported? Review the evidence-based guidelines presented.
do the recommendations align with evidence-based practice guidelines and the patient\’s individual needs? Are there any additional evidence-based recommendations you would add to this presentation? Please include references to support your recommendations.
Reflect on the overall effectiveness of the communication. How could the presenter improve their SBAR presentation for future cases?
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