| Course | NU 673 Psychiatric Mental Healthcare I |
|---|---|
| Unit | Unit 5 |
| Paper type | Medication and cognition review |
| Length | About 890 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Psychiatric Mental Health Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 673 Unit 5
Depression, Dementia, or the Medicine Cabinet? A Medication and Cognition Review for a 79-Year-Old Woman With Low Mood and Memory Loss
Student Name
Department of Nursing, Herzing University
NU 673: Psychiatric Mental Healthcare I
Instructor Name
February 20, 2026
Depression, Dementia, or the Medicine Cabinet? A Medication and Cognition Review for a 79-Year-Old Woman With Low Mood and Memory Loss
The Presentation
Mrs. B., a composite widow of 79, has her own apartment in a senior housing complex. Her daughter brought her to the outpatient psychiatric clinic, reporting six months of low mood, withdrawal, and worsening memory: missed appointments, a burned pot, repeated phone calls about the same question. Her primary care clinician's referral asked whether this is depression or early dementia. She has been on paroxetine for depression for three years. This review sets the presentation beside everything she takes and her current cognition, and asks which of three explanations best accounts for it.
Everything She Takes
The list was built from her pill bottles, which her daughter brought in a bag, her pharmacy record, and her daughter's account of what she buys for her mother.
| Medication and dose | Prescribed by, when | Last reviewed | Relevant concern |
|---|---|---|---|
| Paroxetine 20 mg daily | Primary care, 3 years ago | Not since started | Strongly anticholinergic among antidepressants; strong CYP2D6 inhibitor |
| Oxybutynin 5 mg twice daily | Urology, 2 years ago | Not since started | Strongly anticholinergic |
| Store-brand "PM" pain and sleep tablets with diphenhydramine, every night | Bought by daughter, 6 months ago | Never | Strongly anticholinergic; sedating |
| Zolpidem 10 mg at bedtime | Primary care, 1 year ago | Refilled monthly | Falls, next-day impairment, confusion in older adults |
| Gabapentin 300 mg three times daily | Neurology, for neuropathy, 18 months ago | 6 months ago | Sedation, dizziness; dose depends on kidney function |
| Tramadol 50 mg as needed, about daily | Primary care, 8 months ago | Not since started | Serotonergic with paroxetine; paroxetine may reduce its pain effect |
| Metoprolol 25 mg twice daily; lisinopril 10 mg daily; atorvastatin 20 mg daily | Primary care, years ago | At last physical | Low concern for cognition |
| Omeprazole 20 mg daily | Primary care, 4 years ago | Not since started | Long-term use; no clear indication recorded |
Her Current Cognition
On examination, she was alert but slow to answer and had difficulty holding the thread of longer questions. A screening test for delirium was negative, although her daughter describes her as worse in the mornings. On the Montreal Cognitive Assessment, she scored 20 of 30, losing points mainly on attention, delayed recall, and verbal fluency; she recognized most words she could not recall freely. She was oriented except for the date. Her Geriatric Depression Scale score was in the depressed range. Blood tests from primary care last month showed normal thyroid function, B12, and calcium, and a sodium of 132 mmol/L, mildly low.
Weighing the Three Explanations
Depression is supported by her mood, withdrawal, and screening score, and depression in older adults commonly impairs attention and retrieval. But she has been on paroxetine for three years, and her decline began six months ago, which does not fit a primary relapse without another cause.
A neurocognitive disorder is possible at 79 and cannot be excluded. But the pattern, attention and retrieval impairment with preserved recognition and morning worsening, is not typical of early Alzheimer disease, and the timing matches a medication change.
Medication effects are the most strongly supported explanation for the recent decline. She takes three strongly anticholinergic drugs, paroxetine, oxybutynin, and diphenhydramine, and anticholinergic effects on cognition are cumulative; scales that add up the anticholinergic burden of each drug were developed for exactly this situation (Boustani et al., 2008). The nightly diphenhydramine product began six months ago, when the decline began. Zolpidem and gabapentin add sedation. The current Beers Criteria advise avoiding strongly anticholinergic drugs, including paroxetine, oxybutynin, and diphenhydramine, and zolpidem, in older adults (American Geriatrics Society Beers Criteria Update Expert Panel, 2023). Her mild hyponatremia may also reflect the selective serotonin reuptake inhibitor, a recognized effect in older adults. Long-term cumulative use of strong anticholinergics has also been associated with a higher risk of dementia in a large cohort study (Gray et al., 2015), which adds a longer-term reason to reduce them.
The Plan: One Change at a Time
Each change is made separately, allowing its effect to be judged, and coordinated with primary care, urology, and neurology. First, stop the diphenhydramine product this week, with her daughter's agreement; for sleep, begin sleep hygiene and consider cognitive behavioral therapy for insomnia. Second, over the next four weeks, cross-taper paroxetine to sertraline, which has far less anticholinergic effect and does not block the conversion of tramadol to its active form; paroxetine is tapered slowly because stopping it abruptly causes withdrawal symptoms. Third, ask urology whether oxybutynin can be replaced with a non-anticholinergic option or bladder training. Fourth, taper zolpidem with primary care once sleep is addressed. Fifth, ask primary care to recheck sodium in two weeks and review the tramadol and the indication for omeprazole.
Talking With Mrs. B. and Her Daughter
The review was explained to both of them before any change was made. Mrs. B. was told that several of her medicines, each reasonable on its own, together can slow thinking and memory in someone her age, and that the first step is to remove the ones most likely to be doing this before concluding that her memory is failing. She said she had been afraid she was "going the way my sister did" and was relieved that there was something to try first. Her daughter was upset to learn that the sleep product she had been buying might be contributing and was reassured that it is sold without a prescription precisely because it seems harmless, and that bringing in the bottles was what made the review possible. The daughter agreed to fill a weekly pill organizer and to call the clinic if her mother seems more confused, falls, or has trouble sleeping after the changes, since stopping some of these medicines can cause temporary sleep problems or withdrawal symptoms. A written list of the planned changes, with dates, went home with them, and a copy was sent to each prescriber.
How the Answer Will Be Known
Her Montreal Cognitive Assessment and depression scale will be repeated eight weeks after the anticholinergic changes are complete, with her daughter's account of daily functioning. If cognition improves substantially, medication was the main cause, and any remaining depression is treated on its own. If it does not improve, a neurocognitive evaluation, including brain imaging and neuropsychological testing, follows. Either way, the referral question will have been answered with evidence rather than assumption.
References
American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. https://doi.org/10.1111/jgs.18372
Boustani, M., Campbell, N., Munger, S., Maidment, I., & Fox, C. (2008). Impact of anticholinergics on the aging brain: A review and practical application. Aging Health, 4(3), 311-320. https://doi.org/10.2217/1745509X.4.3.311
Gray, S. L., Anderson, M. L., Dublin, S., Hanlon, J. T., Hubbard, R., Walker, R., Yu, O., Crane, P. K., & Larson, E. B. (2015). Cumulative use of strong anticholinergics and incident dementia: A prospective cohort study. JAMA Internal Medicine, 175(3), 401-407. https://doi.org/10.1001/jamainternmed.2014.7663
NU 673 Unit 5 instructions, in plain terms
Unit 5 asks you to review an older adult's medications for effects on mood and cognition. Expect to describe the presentation, build a complete medication list, assess current cognition, weigh explanations including medication effects, plan changes and explain how you will know whether they worked. Many versions ask you to use the Beers Criteria or an anticholinergic burden scale. Check whether your section expects a medication change recommendation. Build the list from more than one source, because older adults often take over-the-counter products not on any record. Make one change at a time so effects can be judged. Coordinate with other prescribers. Retest after enough time for the change to show.
Inside the NU 673 Unit 5 example
The review opens with the presentation from the daughter's and patient's accounts. The medication list is built from three sources and flags each drug with anticholinergic activity. The cognition section describes examination findings and a screening score. The weighing section takes each explanation and sets out the evidence for and against, noting that the three can coexist. The plan section lists changes in order with timing and who makes each one, starting with the over-the-counter product and moving to the paroxetine cross-taper. The communication section explains how the review was presented to Mrs. B. and her daughter. The final section sets the retest date and what results would point to each explanation.
Where the points sit in the NU 673 Unit 5 rubric
Herzing's rubric for a medication and cognition review grades list completeness, the cognitive assessment, use of the Beers Criteria or burden scales, weighing of explanations, the change plan, coordination and communication. List completeness is checked first, since a missed over-the-counter product can undo the review. Assessment points reward examination findings and a validated screen. Beers and burden criteria look for correct identification of high-risk drugs. Weighing earns credit when explanations are considered together, not one at a time. Plan points go to sequential changes with timing. The 2023 Beers Criteria and Gray's cohort study belong in the APA 7 list. Communication with the patient and daughter, before any change, is usually scored as well.
NU 673 Unit 5 help: mistakes that cost points
Medication and cognition reviews in Unit 5 most often lose points through a list built from the chart alone, which misses over-the-counter sleep aids. Another frequent problem is changing several drugs at once, so effects cannot be judged. Students often attribute everything to dementia or everything to medication. Anticholinergic burden is not measured. Other prescribers are not consulted. Retesting is not planned, or is planned too soon. The patient and family are not told what to expect. Finally, coordinate each change, because graders look for awareness that the urologist or primary care clinician may need to agree before a bladder drug or blood pressure medicine is altered. The daughter's account often holds the over-the-counter products and the timeline of decline, so leaving her out weakens the list.
Get a NU 673 Unit 5 example written to your instructions
Send the Unit 5 instructions and the rubric from your NU 673 classroom, and describe the patient and setting the review should assume. We write a custom example holding the whole medication list, cognition described against a stated comparison point, competing explanations kept open, and questions written for the prescribing clinician. First custom sample free, returned in 24 to 48 hours.
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NU 673 Unit 5 questions, answered
Should the review recommend a medication change?
Write questions, not orders. A practitioner working under supervision documents what they observed, what it might mean and what they are asking the prescriber to consider, and that is also the safest shape for a course example. Anything resembling specific dosing guidance belongs to the clinician who carries the prescribing responsibility for that person, and no example can supply it.
Do I have to name actual drug classes?
Follow your instructions. Where classes are required, keep claims general and attribute anything specific to a current reference rather than to memory, since interaction information is revised and secondhand summaries age badly. The reasoning being graded is usually about whether you considered the full list and held several explanations open, not about reciting particular agents.
How is cognition described without formal testing?
Through function, anchored to a comparison. What the person manages now, what they managed at a stated earlier point, and who supplied that earlier picture carries more than an unexplained number. Where your course requires a screening instrument, name it, say who administered it and treat the result as one piece of evidence among the others.
Where can I find a free NU 673 Unit 5 sample paper?
You can read the whole NU 673 Unit 5 medication and cognition review here for free, the full list, three explanations and the stepwise plan. A review for another older adult can be written on request.
Can medications cause memory loss in older adults?
Yes. Anticholinergic drugs such as diphenhydramine, oxybutynin and paroxetine are linked to confusion and memory problems. This sample finds all three in a 79-year-old woman's regimen and plans to remove them one at a time before diagnosing dementia.