A 75-Year-Old Man With Memory Loss

Introduction. The wife of a 75-year-old previously healthy man calls her internist to report her husband’s acute episode of what she calls “confusion”.

Patient history. Detailed questioning while obtaining the patient's medical history revealed the actual symptom as loss of memory for any events during approximately the last 24 hours. For example, on the morning preceding the event, the patient had placed several folders on his table that were due the next day at his accounting office. When he saw them in the evening, he repeatedly asked his wife about the folders and their due date. Still, he managed to spend the afternoon golfing without any problems and drove himself home without issues before returning home in the evening.

The patient's wife brought him to the office, but there was no complaint of pain or other neurologic symptoms. His personal medical history was unremarkable with no diabetes mellitus, cardiovascular disease, nor chronic medicines other than a statin. The patient did not have bowel or bladder incontinence nor ocular/auditory manifestations. A phone call to a golfing partner revealed he was asymptomatic and fully alert at the end of the golf round.

Physical examination. The patient's physical examination was unremarkable. He did not have an elevated temperature, and all vital signs were within normal ranges. An oral examination showed no evidence of tongue or lip biting. He was awake, alert, and in no distress. He was, however, questioning where he was and how he had gotten there.

Diagnostic examination. A thorough neurological examination was within normal ranges with no signs of paresis, deficits, or lateralizing. He was sent for an urgent head CT, which was preliminarily reported as unremarkable.