Approach to gradual cognitive decline Quiz: Ace Your Exams

A 71-year-old woman presents to the primary care clinic for evaluation of memory concerns. Over the past year, she has experienced gradually worsening forgetfulness. Important appointments have been forgotten, and completing errands without a list has become difficult. Recently, the patient had trouble finding her car in a parking garage. Family members have noted irritability, especially when difficulty arose with cooking a familiar dish. Past medical history includes gastroesophageal reflux managed with omeprazole. Temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 15/min, and blood pressure is 120/80 mmHg. On exam, the patient is alert, oriented, and interactive. The neurological examination reveals no focal abnormalities, and gait is normal. The patient’s Mini-Mental State Examination (MMSE) score is 23/30, and depression screening suggests no symptoms of depression. Which of the following historical elements should be elicited to evaluate for a reversible cause of these symptoms?