What basic labs or other medical work-up would you consider?

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Learning Goal: I’m working on a nursing case study and need an explanation and answer to help me learn.HistoryA 76-year-old retired surveyor is brought to your office by his wife. She reports that he has gradually stopped reading and writing, both activities he used to enjoy. He tends to repeat things many times during the day, apparently unaware that he has mentioned them earlier. He also has more difficulty putting sentences together and forgets the names of common objects such as the radiator and the radio. He has become slightly clumsier. He recently failed to recognize a cousin whom he had not seen for a year. He tells the doctor that he is fine and that his wife is making a fuss about nothing. The previous week he wanted to return a form to claim a chance to win a large prize from a bulk mailing designed to encourage him to attend a promotional timeshare meeting. He would previously have recognized this as a promotion and put it straight in the recycling. He drinks a small bottle of beer twice a week, usually at the weekends, and is a non-smoker. He has not been lethargic or disinhibited and continues to get great pleasure from gardening. His wife describes that onset has been gradual, so much so that she was prompted to act by their daughter.Mental State ExaminationMental state examination shows that he has good eye contact and sits still in a chair throughout the interview. His speech is slightly labored, and, on several occasions, he seems to struggle to find the right word. None of his sentences are long or complex. He has no pressure of speech or flight of ideas. Occasionally he will lose the thread of what he is saying and stop talking or start on a different topic. He is uncertain why he is being interviewed. There is no psychomotor retardation or agitation. There is no evidence of hallucinations or psychosis, although his wife says that he sometimes wakes up in the middle of the night thinking that there is an intruder in the bedroom. His Mini Mental State Examination score is 19. He thinks he is in the hospital to have surgery when in fact he is at your outpatient office.Physical examination is unremarkable, including neurological examination, and he is well nourished. He has some mild eczema. He has good peripheral pulses, no carotid bruits, and a blood pressure of 115/70 mm Hg.QuestionsWhat is the differential diagnosis?
What further questions would you need to ask?
What particular medications should you look out for?
What basic labs or other medical work-up would you consider?
What medication would you start, if any? Why? Include the name (generic and brand), dose, route, and frequency/timing for all medications, and what major side effects about which you would educate the patient/family for the medication you selected

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