| Course | NUR 616 Primary Care of Adults and Gerontological Patients |
|---|---|
| Module | Module 7 |
| Paper type | Milestone case study: cognitive impairment evaluation |
| Length | About 1,040 words, 6 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 616 Module 7
Milestone Two: Evaluating a Memory Complaint in a 74-Year-Old Man, From Screening to Disclosure
[Student Name]
Southern New Hampshire University
NUR 616: Primary Care of Adults and Gerontological Patients
Milestone Two
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Milestone Two: Evaluating a Memory Complaint in a 74-Year-Old Man, From Screening to Disclosure
Memory complaints in older adults are common and frightening, and they are often handled in one of two unhelpful ways: reassurance that forgetfulness is normal aging, or a rapid label of dementia. Mild cognitive impairment lies between normal aging and dementia, and its evaluation has three jobs: measure the impairment, look for causes that can be reversed or reduced and plan for the future with the patient while he can take part fully. This milestone documents the evaluation of a man whose daughter noticed changes. It argues that a structured approach, drawing on the family history, a validated screen and a deliberate search for contributors, leads to an accurate diagnosis and a plan that preserves his independence as long as possible.
History
Mr. S. is a 74-year-old retired accountant who lives with his wife. He says his memory is "not what it was" but that he manages fine. His daughter, interviewed separately with his permission, reports that over the past year he has asked the same question two or three times in a conversation, missed two utility payments that his wife discovered and once got lost driving to a store he has used for years. He still manages his medications with a pill box, cooks simple meals, reads the newspaper and plays golf weekly. There have been no personality changes, hallucinations, falls or sudden declines.
Past history: hypertension, hyperlipidemia and benign prostatic hyperplasia. Medications: amlodipine 5 mg, atorvastatin 20 mg, tamsulosin 0.4 mg and amitriptyline 25 mg at bedtime, started two years ago for sleep. He drinks two glasses of wine each evening. His wife says he turns up the television and often asks people to repeat themselves. He has not had a hearing test. His mood is "fine," though he has given up his book club. Family history: his mother developed dementia in her eighties.
Examination and Testing
Vital signs: seated pressure 132/78 mm Hg, standing 128/76, pulse 68, weight stable. General examination unremarkable. Neurologic examination: cranial nerves intact; no focal weakness, rigidity or tremor; gait normal with normal arm swing; no primitive reflexes. Whispered voice test: missed bilaterally at 60 cm.
Montreal Cognitive Assessment: 23 of 30, with 16 years of education so no point was added. Points were lost on delayed recall, recalling 1 of 5 words and improving with category cues; on clock drawing; and on serial sevens. The MoCA was chosen because, in its validation study, it picked up 90% of the people who had mild cognitive impairment, where the older MMSE caught only 18% (Nasreddine et al., 2005). PHQ-9: 6. Functional Activities Questionnaire: 5, reflecting help needed with bills and travel.
Laboratory results: complete blood count, metabolic panel and TSH normal; vitamin B12 245 pg/mL, low-normal, with methylmalonic acid mildly raised; syphilis and HIV testing not indicated by history.
Assessment
Probable mild cognitive impairment, amnestic type, with possible contributing factors. His MoCA of 23 with impaired delayed recall, his daughter's observations and mild difficulty with complex tasks such as bills point to mild cognitive impairment; dementia would require that the decline interfere with his independence, and he still runs most of his own day. The 2018 AAN guideline reports that mild cognitive impairment affects about 10% of people aged 70 to 74 and that about 15% of those over 65 with it develop dementia within two years; it recommends assessing with validated tools, evaluating modifiable risk factors, stopping cognitively impairing medications where possible and monitoring over time (Petersen et al., 2018).
Several contributors can be addressed. Amitriptyline has strong anticholinergic effects and can impair memory in older adults. His daily alcohol, uncorrected hearing loss and borderline B12 deficiency may each add to his difficulties. Hearing loss is also one of the largest potentially modifiable risk factors for dementia identified by the Lancet Commission, which estimated that 12 modifiable factors together account for about 40% of dementia worldwide (Livingston et al., 2020). His mood score is low, making depression an unlikely main cause. Normal gait, no rigidity or tremor and no hallucinations make Lewy body disease and Parkinson disease less likely, and the absence of stepwise decline or focal signs argues against a large vascular component, although the MRI will address small vessel disease.
Plan
Medications: taper amitriptyline over two weeks and address sleep with cognitive behavioral strategies for insomnia. Alcohol: advise no more than one drink a day. Vitamin B12: start oral cyanocobalamin 1,000 mcg daily and recheck in three months. Hearing: audiology referral for hearing aids. Imaging: brain MRI to look for vascular disease or a structural cause. Referral for neuropsychological testing to confirm the pattern and establish a baseline. Exercise: continue golf and add brisk walking at least twice a week, which the AAN guideline notes is likely to improve cognitive measures. Repeat MoCA in 6 to 12 months, after the reversible factors have been addressed.
Disclosure and Planning
With his permission, the findings were discussed with Mr. S. and his daughter together. He was told that his testing shows a mild problem with memory beyond what is expected for his age, that some of it may improve once the sleep medicine is stopped and his hearing is corrected, and that many people with this condition remain stable. He was also told honestly that it raises the chance of dementia in the future. Driving: because he got lost once, a formal driving assessment was recommended, and he agreed to drive only on familiar routes in daylight until it is done. Finances: his wife will take over bill paying for now, with automatic payments set up. Advance care planning: he was encouraged to name a health care agent in writing and talk through his wishes while he can fully take part. Follow-up in six weeks.
Conclusion
Mr. S. has probable amnestic mild cognitive impairment with several contributors that can be reduced: an anticholinergic sleep aid, alcohol, hearing loss and low B12. Documenting the collateral history, a validated screening score, a function review and the search for contributors allowed an accurate diagnosis and a plan that protects his safety and his say in his own future. The final project will bring these findings into a comprehensive plan.
References
Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Kivimaki, M., Larson, E. B., Ogunniyi, A., . . . Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413-446. https://doi.org/10.1016/S0140-6736(20)30367-6
Nasreddine, Z. S., Phillips, N. A., Bedirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695-699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
Petersen, R. C., Lopez, O., Armstrong, M. J., Getchius, T. S. D., Ganguli, M., Gloss, D., Gronseth, G. S., Marson, D., Pringsheim, T., Day, G. S., Sager, M., Stevens, J., & Rae-Grant, A. (2018). Practice guideline update summary: Mild cognitive impairment. Neurology, 90(3), 126-135. https://doi.org/10.1212/WNL.0000000000004826
What the NUR 616 Module 7 instructions ask for
Milestone Two in NUR 616 usually asks you to extend the case study with a more complex problem or a follow-up visit, often a geriatric syndrome such as cognitive impairment, falls, incontinence or polypharmacy. Expect to document the history, examination, standardized assessments and diagnostic workup, give an assessment and develop a plan that includes safety and planning issues. Most versions run four to six pages in APA 7. Use a collateral informant where cognition is in question, report screening scores with the domains affected, search deliberately for reversible contributors and address disclosure, driving and advance care planning, since geriatric milestones are graded on the whole person, not only the diagnosis. Keep the informant's account separate.
How this NUR 616 Module 7 milestone two example is built
The sample evaluates a composite 74-year-old retired accountant whose daughter reports repeated questions, missed bills and one episode of getting lost. The history combines his account and hers and records nightly amitriptyline, two glasses of wine a day and apparent hearing loss. Testing documents a MoCA of 23 with the domains where points were lost, the Nasreddine validation data, a PHQ-9 of 6 and a Functional Activities Questionnaire of 5, with a low-normal B12. The assessment uses the 2018 AAN guideline and the Lancet Commission to diagnose probable amnestic mild cognitive impairment with modifiable contributors. The plan tapers amitriptyline, treats B12, refers for audiology, imaging and testing and addresses driving and planning.
Where the NUR 616 Module 7 rubric puts the points
Milestone Two rubrics usually score the comprehensiveness of the history, use of validated assessment tools, a thorough search for contributing causes, accurate diagnosis, an evidence-based plan, attention to safety and ethics and APA 7 writing. Top-band work distinguishes mild cognitive impairment from dementia by function, reports screening results in detail and removes cognitively impairing medications. Graders reward disclosure handled with consent and balanced language and plans that address driving, finances and advance care planning. Scheduling reassessment after reversible factors are addressed shows an understanding of how contributors can affect test scores, which often earns credit under clinical reasoning and under follow-up planning as well.
NUR 616 Module 7 help: the mistakes that cost points
Cognitive evaluation milestones lose points when the diagnosis rests on one screening score, when no collateral history is obtained, when anticholinergic medications are left in place, when hearing and mood are not assessed or when dementia is diagnosed in a person who is still independent. Another frequent gap is avoiding disclosure or safety topics. Use an informant, report scores by domain, search for reversible contributors, distinguish mild cognitive impairment from dementia by function, disclose with consent and address driving and planning. If your milestone involves falls, urinary incontinence or polypharmacy instead, send the case and guidelines for a milestone built on that syndrome and the tools used to measure it.
Get NUR 616 Module 7 written to your instructions
Share the scenario, your milestone instructions and the grading rubric. A milestone that uses validated tools, searches for reversible contributors, distinguishes mild cognitive impairment from dementia by function and handles disclosure and safety will be ready in 24 to 48 hours, and the first costs nothing. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
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NUR 616 Module 7 questions, answered
Where can I find a free NUR 616 Module 7 Milestone Two sample?
You can read the whole milestone here: a memory complaint in a 74-year-old man, with MoCA scoring, reversible contributors, a diagnosis of mild cognitive impairment and a disclosure plan.
What is the difference between mild cognitive impairment and dementia?
Both involve measurable cognitive decline, but in mild cognitive impairment the person remains largely independent in daily activities, while dementia interferes with independence.
Why use the MoCA instead of the MMSE?
In its validation study, the MoCA detected about 90% of people with mild cognitive impairment, compared with 18% for the MMSE, because it tests executive function and delayed recall more thoroughly.
Which medications can worsen memory in older adults?
Drugs with anticholinergic effects, such as amitriptyline, diphenhydramine and oxybutynin, and sedatives such as benzodiazepines. The AAN guideline advises stopping cognitively impairing drugs where possible.
How often does mild cognitive impairment progress to dementia?
The 2018 AAN guideline reports that about 15% of people over 65 with mild cognitive impairment develop dementia within two years, while some remain stable or improve.