–Mini-Cog score:_______
-Further cognitive testing at next visit.
-CBC; CMP; TSH, vitamin B12, folate, and calcium levels performed.
-Will treat cognitive and functional symptoms.
-Recommend cognitive stimulation programs for the maintenance of cognitive function and quality of life.
-Recommend a structured program of physical exercise to improve physical function and reduce rates of neuropsychiatric symptoms
–Donepezil (Aricept) 5 to 10 mg PO daily or another cholinesterase inhibitor.
-Memantine (Namenda) 20 mg daily. Will start with 5mg po QD, increase by 5mg/day no more frequently than qwk; max 20mg/day.
-Vitamin E 2,000 IU per day will be combined with a cholinesterase inhibitor.
Will Consider neuroimaging, CSF analysis, HIV testing, Lyme titer, RPR test in the future.
—END—
Memantine (Namenda) is an NMDA receptor antagonist. It binds N-methyl-D-aspartate receptors. It may also slow calcium influx and nerve damage.
Donepezil is a cholinesterase inhibitor. It reversibly binds to and inactivates acetylcholinesterase.
References
http://www.aafp.org/afp/2017/0615/p771.html
http://www.aafp.org/afp/2016/1201/p880.html