Presenting Complaints

The patient, a 37-year-old male, presents with a chief complaint of progressive memory loss over the past 6 months.

History of Presenting Complaint

The patient reports that he has been experiencing increasing difficulty remembering recent events, names of acquaintances, and where he has placed common household items. He states that these memory lapses have been interfering with his daily activities and causing him significant distress. The patient denies any history of head injury, stroke, or other neurological conditions. He reports no changes in vision, speech, or motor function.

Significant Positives & Negatives For Differentials

Alzheimer's disease

Positives:

• Progressive memory loss
• Insidious onset
• Impairment in other cognitive domains (e.g., language, visuospatial skills, executive function)
• Functional impairment in daily activities
• Family history of dementia

Negatives:

• Lack of significant impairment in other cognitive domains
• Absence of functional impairment in daily activities
• No history of head injury or stroke

Vascular dementia

Positives:

• History of hypertension
• Stepwise cognitive decline
• Focal neurological signs (e.g., hemiparesis, sensory deficits)
• Neuroimaging evidence of cerebrovascular disease

Negatives:

• Absence of focal neurological signs
• Lack of stepwise cognitive decline
• No clear history of stroke or other cerebrovascular events

Depression-related cognitive impairment

Positives:

• History of depression
• Cognitive impairment, particularly in attention and executive function
• Improvement in cognitive function with treatment of depression

Negatives:

• Absence of depressive symptoms
• Lack of significant impairment in other cognitive domains

Alcohol-related cognitive impairment

Positives:

• History of chronic, heavy alcohol consumption
• Impairment in memory, attention, and executive function

Negatives:

• Absence of significant alcohol consumption
• Lack of other neurological symptoms associated with alcohol-related cognitive impairment (e.g., ataxia, peripheral neuropathy)

Past Medical History

The patient has a history of hypertension, which has been well-controlled with medication. He has no other significant medical conditions.

Drug/Medication History

The patient takes hydrochlorothiazide for his hypertension. He denies any other regular medication use.

Social History

The patient is married and works as an accountant. He reports a history of moderate alcohol consumption, drinking 2-3 glasses of wine per day. He is a non-smoker and denies any illicit drug use.

Family History

The patient's mother has a history of depression, but there is no known family history of dementia or other neurodegenerative disorders.

Systems Review

The review of systems is otherwise unremarkable, with no significant findings in the cardiovascular, respiratory, gastrointestinal, or musculoskeletal systems.

Ideas, Concerns & Expectations

The patient is concerned that his memory problems may be a sign of a more serious underlying condition, such as Alzheimer's disease. He is worried about the potential impact on his work and personal life and is seeking a thorough evaluation and appropriate treatment.

Case Presentation

Based on the information provided, the most likely diagnosis is mild cognitive impairment (MCI). The patient's presentation of progressive memory loss, without significant impairment in other cognitive domains or daily functioning, is consistent with MCI. While the patient's history of hypertension and moderate alcohol consumption could contribute to his memory problems, the lack of other neurological symptoms or significant medical comorbidities makes Alzheimer's disease or vascular dementia less likely as the primary cause at this stage. Further evaluation, including neuropsychological testing and neuroimaging, would be necessary to confirm the diagnosis and rule out other potential etiologies.