Assignment:Patient with Moderate Dementia

A.J., a patient with moderate dementia, was admitted last summer to a nursing home. Today, her daughter brings her in for her annual follow-up. The daughter tells you that over the past 2 months her mother has become increasingly irritable. She now spends most of the time in her room, no longer playing cards and bingo. Last week she declined her daughter’s invitation to join a family picnic, something that she always used to enjoy. In addition, staff tell the daughter that A.J. has been resisting taking her medication and is sleeping poorly at night. What is the most likely diagnosis?

a. An episode of acute delirium

b. Primary insomnia

c. Depression superimposed on dementia

d. An evolving serious medical problem, such as cancer or severe anemia

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