hardbenzodiazepineslorazepamelderlycognitive impairmentMoCAneurodegenerative diseasedeprescribinggeriatric psychiatry
A 74-year-old female with generalized anxiety disorder has been taking lorazepam 0.5 mg twice daily for six years, prescribed by her previous provider. She presents to the PMHNP for an initial evaluation after relocating. She reports the lorazepam controls her anxiety well and she has no complaints. Her daughter, who accompanied her, expresses concern about increasing forgetfulness over the past two years, including missed appointments, repeated questions during conversations, and difficulty managing her finances. The patient attributes these changes to normal aging. Her Montreal Cognitive Assessment (MoCA) score is 21 out of 30, with particular deficits in delayed recall, attention, and executive function. Her GAD-7 score is 6. She has no history of head injury, stroke, or family history of dementia. Her TSH, B12, folate, and comprehensive metabolic panel are all within normal limits. Brain MRI obtained by her primary care provider shows mild generalized cortical atrophy without focal lesions or significant white matter disease. The PMHNP is evaluating the relationship between the long-term benzodiazepine use and the cognitive decline. Which of the following best represents the appropriate evaluation?