A 70 year old woman is brought in by her son, after she was found wandering the streets. She has become progressively disoriented, confused, and forgetful over the last 2 years. Her medical history is only significant for mild hypertension and dyslipidemia for 4 years, which are well controlled on Ramipril and Atorvastatin. She has never smoked, and only drinks socially. She was educated up to high school, and speaks your language fluently. A routine health checkup 3 months ago revealed her fasting plasma glucose levels, serum electrolytes, and liver and renal functions to all be within normal parameters.
WBC: 9,000/mm3 (4,600-11,000) N: 65% L: 25% Hb: 12.8 g/dL (11-18) Platelets: 158,000/mm3 (150,000-450,000)
TSH: 1.2 mIU/L (0.3-3.04) Free T3: 2.7 pg/mL (2.5-3.9) Free T4: 0.82 ng/dL (0.61-1.12) Serum B12: 820 pg/mL (180-914)
Magnetic resonance imaging reveals mild atrophy of both medial temporal lobes, with the hippocampal structures particularly affected. No other structural abnormalities are detected.
Geriatric Depression Scale Score: 2/15 (normal)