With the case study below, what are some differential diagnosis and what would you recommend. Please use references within the past 5 years and cite.

Mrs. Simmons, an 84-year-old widow, is brought to the office by her daughter, Mary. She is a retired office worker and has 2 children, a son Stephen who lives out of state and her daughter. Mary claims that her mother seems to be depressed. There is a history of depression approximately 5 years ago, shortly after Mrs. Simmons's husband died. At that time, she was successfully treated with antidepressants. Currently, the daughter states that her mother's memory for appointments and events has declined severely, and she seldom drives because she does not seem interested in shopping or going out like she used to do. The daughter also noted that her mother's house seemed very disorganized and dirty, there was a limited amount of food in the kitchen, and several unpaid bills were noted on the dining table, now past due.

Mrs. Simmons appears somewhat uncomfortable, shifting in her seat often. She denies any physical pain, she makes only brief eye contact with each question. Her affect is flat, showing no emotion and very little facial expression. She denies auditory or visual hallucinations, reports sleeping more than usual and having a decreased appetite. Whan asked how she feels her mood is she reports, "Okay." She also reports no thoughts of self harm, harm to others or suicide.

PMH: HTN, Osteoarthritis in right knee, Hearing loss (bilateral hearing aids in use). Depression - treated for 1 year after the death of her husband, then resolved.

Allergies: sulfamethoxazole/trimethoprim - nausea and vomiting

Medications:

• Lisinopril 12.5mg PO daily
• Vit D 2,000 IU PO daily
• Ibuprofen 200mg 2 tabs PO 1 - 2 times daily as needed
• Voltaren gel apply small amount to affected area once daily

Social History: as stated in case history, plus Mrs. Simmons does not drink alcohol, she has an associates degree in business management.

ROS: as stated in case history, also no headaches, dizziness, or muscle aches.

Diagnostics/Assessments done:

1. MoCA - score 27/30 - points missed for attention and orientation. Instructions for MoCA attached:
2. Neuro exam - psychomotor slowing
3. GDS - review completed form by Mrs. Simmons
4. Labs - CBC, CMP, TSH, B12, Folate - all within normal limits