4th September 2020

A 72-year old woman attends memory clinic, following a GP referral

A 72-year old woman attends memory clinic, following a GP referral. She is seen with her husband, who has had concerns about her memory for several months. The patient appears to be completely disorientated to her surroundings, and despite you repeatedly introducing yourself, is unable to recall your name or role. When asked why she is in clinic, she explains that she was recently mugged in the street, and that this has meant she can no longer work at the bank. Her husband states that this account is false. He also tells you that her past medical history includes hypertension, type 2 diabetes and TIAs; she takes ramipril, simvastatin, aspirin and metformin as regular medications; they live alone, and that his wife enjoys drinking – probably drinking a bottle of white wine each night, and “sometimes more”. Routine blood tests reveal a macrocytic anaemia.

Which of the following nutrients is the patient most likely to be deficient in, resulting in the clinical syndrome described?

Select the SINGLE most appropriate option from the list below. Select ONE option only.