23rd August 2024

A 63-year-old man presents with worsening cognitive impairment over the past two years

A 63-year-old man presents with worsening cognitive impairment over the past two years. He has a background of alcohol excess and routinely used to drink 1 L of whiskey daily until he enrolled with the substance misuse team five years ago and has since been abstinent. His wife thinks he is depressed as he has recently been more irritable and apathetic and is concerned it may be due to his previous alcohol consumption.

Peripheral and cranial nerve examination are normal within the limitation of comprehending examination instructions. His score on MoCA testing is 21/30 and he has scored poorly on animal naming and language. As part of his further testing, he can repeat phrases back but has great difficulty in naming objects that you present to him. He speaks fluently but references ‘this, that and the other’ frequently with significant perseveration.

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