Differential Diagnosis
- Single most likely diagnosis
- E) Normal aging: The patient's symptoms of word-finding difficulty and occasional trouble recalling names are common in normal aging. Her speech is fluent, and she recalls four of five objects after 5 minutes, which suggests that her cognitive function is relatively preserved. The absence of significant cognitive decline or other red flags makes normal aging the most likely diagnosis.
- Other Likely diagnoses
- D) Mild cognitive impairment: The patient's symptoms could also be consistent with mild cognitive impairment, particularly given her report of word-finding difficulty. However, her performance on the memory test and the absence of other cognitive deficits make this diagnosis less likely than normal aging.
- C) Functional neurologic disorder: The patient's anxiety and report of cognitive symptoms could be suggestive of a functional neurologic disorder, but there is no clear evidence of a psychological or emotional trigger for her symptoms.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- B) Frontotemporal dementia: Although frontotemporal dementia is a less likely diagnosis given the patient's relatively preserved cognitive function, it is a potentially devastating condition that can present with subtle symptoms. Early diagnosis and intervention are crucial, making it essential to consider this diagnosis.
- A) Alcohol-related cognitive impairment: The patient's daily wine consumption could potentially contribute to cognitive impairment, although her reported amount of alcohol consumption is relatively moderate. It is essential to consider this diagnosis, especially if her symptoms worsen or if she has a history of heavy drinking.
- Rare diagnoses
- Vitamin B12 deficiency: Although not explicitly mentioned in the patient's history, a vitamin B12 deficiency can cause cognitive symptoms, including word-finding difficulty and memory impairment. This diagnosis is relatively rare but can be easily tested for and treated if necessary.
- Subclinical thyroid disease: Subclinical thyroid disease can cause cognitive symptoms, including memory impairment and word-finding difficulty. Although the patient's history does not suggest thyroid disease, it is a rare but potential diagnosis that could be considered if other causes are ruled out.