CASE 62: MEMORY LOSS
History
A 38-year-old man presents to a neurologist having been referred because of memory loss
and difficulty with concentration. He has recently lost his job in a high-street bank because
of his increasingly poor performance at work. His wife and friends have noticed the decline
in his memory for recent events over the past 6 months. The patient is sleeping poorly and
has developed involuntary jerking movements of his limbs especially at night. He appears
to his wife to be very short-tempered and careless of his personal appearance. He is mar-
ried with two children and neither smokes tobacco nor drinks alcohol. He is not taking any
regular medication. Aged 15, he received 2 years’ treatment with growth hormone injec-
tions because of growth failure.
Examination
In the nervous system, muscle bulk, power, tone and reflexes are normal but there are occa-
sional myoclonic jerks in his legs. The examination of cardiovascular, respiratory and
abdominal systems is entirely normal. Funduscopy is normal. Mini-mental test scoring is
grossly subnormal (4 out of 10).
- What is the name of this place?
- What is the address of this place?
- What is the date?
- What month is it?
- What year is it?
- How old are you?
- When is your birthday?
- What year were you born?
- Who is the Prime Minister?
- Who was the previous Prime Minister?
! Mini-mental State questionnaire
Questions
- What is the diagnosis?
- What are the major differential diagnoses of this condition?
- How would you investigate and manage this patient?