Eleanor R. · care plan refresh

Subjective

Patient reports no concerns and describes her sleep, appetite and mood as unchanged. She manages her own medications and finances independently and stopped driving at night in spring 2026 on her own initiative, attributing it to glare rather than confusion. She acknowledges that her daughter has raised repetition in conversation and attributes it to age. She did not volunteer any difficulty with names or word finding, though she paused twice during the functional questions in a way she covered with "you know the one."

Objective

Third consecutive screen with a MyCog total of 24 to 25, no threshold crossed. Delayed recall two of three for the second consecutive screen. PHQ-9 four, GAD-7 two, both stable. All IADLs independent by self report, no collateral this call. Clarity word finding effort 71, up from 61 in March and 52 at baseline. Speech timing 66, up from 57. Articulatory precision 38, flat across all three screens. Mean retrieval latency 4.1 seconds against 2.2 seconds in March.

Assessment

1. Amnestic mild cognitive impairment, clinically stable by score and progressing by voice trend across eleven months.
2. Rising word finding effort with flat articulatory precision favours a retrieval rather than a motor speech process.
3. Subclinical hypothyroidism, TSH 6.8, potentially contributory and worth correcting before attributing anything to progression.
4. Caregiver concern raised informally by daughter and not yet formally assessed.

Plan

• Bring the annual recheck forward to a four month interval, next screen due November 2026.
• Repeat TSH and free T4 in six weeks, treat if TSH remains above 6.0 with symptoms.
• Refer to neuropsychology for formal testing, referral placed Jul 28.
• Navigator call offered to the daughter, with the patient's consent obtained on this call.
• Documentation structured for CCM 99490, time captured from the call log.