hardtopiramatequetiapinecognitive side effectsMoCAbipolar IImedication adverse effectsword-finding difficulty
A 55-year-old female with bipolar II disorder and comorbid migraine has been taking topiramate 200 mg daily for migraine prophylaxis and quetiapine 300 mg at bedtime for mood stabilization for the past six months. She presents with complaints of word-finding difficulty, slowed processing speed, and trouble concentrating at her accounting job. She reports these cognitive symptoms developed gradually over the past several months and were not present before starting her current medication regimen. Her mood has been stable and migraines are well controlled. Montreal Cognitive Assessment (MoCA) score is 23 out of 30, with deficits noted in attention, language fluency, and delayed recall. The PMHNP is evaluating the cognitive complaints in the context of her medication regimen. Which evaluation approach is most appropriate?