This page reveals the answer
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Five progressive clues
These are the case findings in their original reveal order, moving from the broader presentation to the most discriminating evidence.
Clue 1
A 72-year-old retired schoolteacher is brought to a clinical psychologist by her daughter, who is worried about the last two years. Once meticulous about birthdays and grocery lists, she now repeats the same questions within minutes and recently drove past her turnoff and got lost coming home from the church she has attended for thirty years.
Clue 2
The changes began so gradually the family cannot name a start date, and they have worsened steadily rather than in sudden steps. She forgets conversations from earlier the same day, retells stories, and leans ever more heavily on sticky notes; memories from decades ago remain vivid. There have been no falls, no fainting, no visual hallucinations, and no change in her personality. Her own mother declined similarly in her seventies.
Clue 3
During the interview she waves the concerns away as ordinary aging and insists she is managing fine, while her daughter quietly lists missed medications and a scorched pot left on the stove. Her mood is bright and engaged, her gait is normal, and there is no tremor or slowness of movement.
Clue 4
On formal neuropsychological testing her attention and digit span are near normal, but after a short delay she can recall only 1 of a 10-word list, and crucially her recall does not improve when given category cues or a recognition list. Orientation to date and place is impaired. Her total cognitive screen score is 19/30, with most points lost on delayed recall and orientation.
Diagnosis
Alzheimer Disease
Why the diagnosis fits
The picture is an insidious, steadily progressive amnestic syndrome: prominent anterograde episodic memory loss with rapid forgetting, relatively preserved attention early, and anosognosia (the patient minimizes deficits her family clearly reports). The single key discriminator is that delayed recall fails to improve with semantic cueing or recognition, indicating a storage/consolidation failure of medial-temporal origin rather than the retrieval failure of depression-related pseudodementia (where cueing helps and patients over-report deficits). The absence of stepwise decline and focal signs argues against vascular disease, and the absence of fluctuations, visual hallucinations, and parkinsonism argues against Lewy body disease; the CSF low amyloid-beta 42 with elevated phospho-tau plus disproportionate hippocampal atrophy seals it.
Educational reference
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