A 60-Year-Old Woman With Worsening Neuropsychiatric Symptoms

Sridharan Ramaratnam, MD


August 12, 2015

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A 60-year-old woman from northeastern India presents with abnormal behavior, irritability, disorientation, forgetfulness, and unsteadiness while walking, leading to repeated falls. Her symptoms have progressed gradually over the past 3 months; she is now unable to recognize her immediate family or feed herself orally and has become incontinent. She has also developed intermittent, jerking limb movements but has had no tonic-clonic seizures or headaches.

She has no history of hypertension or diabetes. She has not undergone any recent surgeries or received any transfusions of blood products in the past. She is the mother of two children and underwent menopause 10 years ago. Her husband has worked in the United Kingdom for the past 20 years while she has lived in India, looking after her family; occasionally she spends a few months at a time visiting with her husband in the UK. She is a vegetarian. She has a family history of heart disease, with both of her parents dying of cardiovascular disease, but no other family history of medical illness.


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