26th June 2023

An 83-year-old man is brought in by his wife, stating that over the past 4 months, he has become increasingly confused

An 83-year-old man is brought in by his wife, stating that over the past 4 months, he has become increasingly confused. She first noticed it when he was repeatedly cleaning the car every day, forgetting he had done it the day before, and struggling to remember which month it was. He was overheard speaking to his neighbours about his daughters both being in university when they had completed their degrees many years previously.

His wife had assumed it was normal ageing and had not presented to services before today. However, after she had returned from walking the dog earlier in the day, she had found her husband vacant and disorientated in the garden, he had urinated himself and there was dry blood at the corner of his mouth. He had vomited the evening before after supper and taken to bed earlier than usual.

His past medical history includes heart failure (with a reduced ejection fraction of 35%), pleural plaques, macular degeneration, and gout. He takes bisoprolol, atorvastatin, allopurinol, and cholecalciferol.

On examination, he appears settled. Cardiorespiratory exam is unremarkable. He is confused (AMTS 4/10) but there is no focal neurology identified, pupils are equal and reactive to light with no photophobia.

Observations: BP 162/89mmHg, HR 86, Sats 97% on air, RR 16, Temp: 37.4 degrees

Blood tests, chest x-ray, and urine MC&S are pending.

An MRI head is performed but has not yet been reported.

CT head

Given the history, which of the following medications would be most appropriate to start first?

Select the SINGLE most appropriate option from the list below. Select ONE option only.