Assessment of the Patient

To assess the patient, a comprehensive approach would be taken, including:

• A thorough medical history to identify any pre-existing conditions or medications that could contribute to the symptoms.
• A physical examination to evaluate the patient's mobility and overall health.
• A cognitive assessment, such as the Mini-Mental State Examination (MMSE), to evaluate memory, attention, and other cognitive functions.
• Laboratory tests to rule out reversible causes of dementia, such as vitamin B12 deficiency or thyroid disorders.
• Imaging studies, like MRI or CT scans, to evaluate for structural changes in the brain.

Differential Diagnoses

Single Most Likely Diagnosis

• Alzheimer's Disease: Given the gradual decline in memory and physical mobility over the past year, Alzheimer's disease is a strong consideration. It is the most common cause of dementia among older adults, characterized by progressive cognitive decline.

Other Likely Diagnoses

• Vascular Dementia: This is the second most common cause of dementia and can present with similar symptoms to Alzheimer's, especially if the patient has a history of stroke or vascular disease.
• Mixed Dementia: Many patients have a combination of Alzheimer's disease and vascular dementia, which can make diagnosis and treatment more complex.

Do Not Miss Diagnoses

• Normal Pressure Hydrocephalus (NPH): Although less common, NPH can cause dementia, gait disturbance, and urinary incontinence. It is treatable with the placement of a shunt, making it a crucial diagnosis not to miss.
• Hypothyroidism: Severe, untreated hypothyroidism can cause cognitive decline and dementia-like symptoms, which are reversible with thyroid hormone replacement therapy.
• Vitamin B12 Deficiency: A deficiency in vitamin B12 can lead to neurological symptoms, including dementia, which can be treated with supplementation.

Rare Diagnoses

• Frontotemporal Dementia: A group of diseases characterized by the progressive degeneration of the frontal and/or temporal lobes of the brain, leading to significant changes in personality, behavior, and language.
• Creutzfeldt-Jakob Disease: A rare, degenerative, fatal brain disorder that leads to dementia and other neurological problems, though it progresses much more rapidly than Alzheimer's disease.
• Chronic Subdural Hematoma: More common in the elderly after minor trauma, it can cause gradual cognitive decline and is treatable with surgical intervention.

Initial Treatment Plan

The initial treatment plan would focus on:

• Diagnostic Clarification: Further testing and evaluation to confirm the diagnosis.
• Supportive Care: Providing support to the patient and her family, including education on the disease process and available resources.
• Safety Assessment: Ensuring the patient's safety at home, which may involve removing hazards and considering assistive devices.
• Medication Review: Evaluating the patient's current medications to minimize polypharmacy and potential drug interactions.
• Referral to Specialists: Depending on the diagnosis, referrals to neurology, geriatrics, or other specialists may be necessary for further management.

This approach allows for a comprehensive evaluation and the development of a personalized treatment plan based on the patient's specific needs and diagnosis.