Mrs. S is a 65 year old Chinese-Thai women who presents with symptoms of forgetfulness. She has trouble remembering names and the location of certain keys on her computer keyboard. Her past medical history includes uncomplicated shingles and treatment with prednisone for temporal arteritis between the ages of 61-64, with residual osteoporosis. Consequently, she has been taking calcium supplements as well as low doses of thyroid replacement therapy.
Ten months later, Mrs. S is re-examined and she reports that her memory impairment has worsened and is now embarrassing her. The neurologic exam shows that she has buccolingual and limb apraxia. Her clock drawing is impaired in that she has put in at least 15 numerals and has no idea how to place the hands of the clock.