A 51-Year-Old Woman With Cognitive and Functional Decline

Lisa C. Silbert, MD; Deniz Erten-Lyons, MD

Disclosures

September 03, 2015

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 51-year-old woman is brought in by her husband, who reports that she has had slowly progressive cognitive decline for around 2 years. The initial symptoms were memory loss, forgetting conversations, repeating herself, and asking the same question within a short period. She had been working as a mortgage underwriter for 20 years and was laid off from her job 18 months ago. She took another position doing a similar, but less demanding, job and was let go from that job 7 months ago. Her husband notes that she was having difficulties remembering the password that she used every day.

The patient has had difficulty remembering names of characters in the TV shows she watches and is having problems looking things up on the Internet. She is no longer able to write checks, and her husband has taken over the bills and finances. The patient has lived in the same city for 49 years but now gets easily turned around in familiar places. She continues to be in relatively good spirits but is noted to have episodes of severe anxiety.

The patient has had a history of irritable bowel syndrome but has otherwise been healthy. She is taking over-the-counter vitamin supplementation and is not on any prescription medications. She denies any focal neurologic symptoms and has not had any headaches, fevers, or seizures. She denies illicit drug use or excessive alcohol consumption.

Both of her parents are 72 years old and cognitively healthy. She had 1 year of college education.

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