Frankly Forgetful Frank

Frank, a 58-year-old carpenter, was brought to the hospital because he built a crooked fence. According to his family, he had built a picket fence in which the slats were slanted and then insisted that they were vertical. On further questioning, it became clear that there had been gradually increasing memory deficit and forgetfulness, neglect of personal hygiene, and mistakes in bookkeeping in his business affairs over a 2 year period. There was no family history of nervous or mental disease.

On examination he was a pleasant, smiling, middle-aged man who was disoriented to time and had poor recent memory. His fund of general knowledge and ability to do calculations and abstract thinking were all abnormal. There was a mixed expressive-receptive dysphasia. He was unable to identify the parts of his body, name his fingers, or tell right from left. Constructional and dressing apraxia were present. Aside from snout, grasp, and palmomental reflexes, the remainder of the neurologic exam was normal.

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