Mrs. M is a 72-year-old woman who presents for routine follow-up to the cardiovascular clinic. She and her family report increasing forgetfulness manifested as trouble remembering names and finding words. Further questions to her family about her memory reveal that, approximately 5 years earlier, she started to forget her keys or misplace items often. Since then, she often forgets appointments and her family thinks her memory is slightly worse.

She is currently independent in all her activities of daily living (bathing, toileting, transferring, eating, dressing without any incontinence) and independent in all her independent activities of daily living (telephone, transportation, chores [laundry, cooking, cleaning], managing money). She occasionally has problems with forgetting medications.

Her medical and surgical history includes hypertension, hyperlipidemia, paroxysmal atrial fibrillation, osteoarthritis, and prior bilateral knee replacement surgeries. She has no history of strokes. Her medication regimen consists of metoprolol succinate 50 mg daily, apixaban 5 mg twice daily, losartan 25 mg daily, and atorvastatin 40 mg daily.

On examination, she is in no acute distress. Her blood pressure is 135/80 mm Hg and heart rate is 82 bpm.

Her cardiovascular examination reveals an irregular rhythm with an early peaking soft systolic murmur best heard at the right upper sternal border. Her lung examination reveals diminished breath sounds at the bases and is clear to auscultation bilaterally otherwise. Neurologic examination findings are unremarkable. She does not demonstrate any bradykinesia or cog-wheel rigidity and has a normal affect and thought process.

A Mini-Cog test is administered, in which she scores 3 of 5 possible points. She is referred by the cardiovascular team to a memory clinic. A Montreal Cognitive Assessment (MoCA) is administered, in which she scores 25 of 30 possible points. She lost 2 points on serial subtraction, 1 point on language fluency, and 2 points on delayed recall (without recall after category and multiple-choice cues).

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Dyslipidemia, Geriatric Cardiology, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism, Statins, Sleep Apnea

Keywords: Aged, Activities of Daily Living, Metoprolol, Losartan, Atorvastatin, Atrial Fibrillation, Hypokinesia, Systolic Murmurs, Hyperlipidemias, Follow-Up Studies, Mental Status and Dementia Tests, Dementia, Auscultation, Osteoarthritis, Succinates

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