Mrs. S, born in 1913, was brought in by her husband in September 1989. He was very worried about her failing memory and poor balance which he had noted for about six months. The year before that she had lost 20 pounds. This he ascribed to poor dentures so that she could not chew even though she had a good appetite and was hungry. She was able to run her household and to do crossword puzzles. Because of her poor balance she had fallen several times.

She had noted any perceptual experiences. Her memory was very poor especially for recent events, she was confused and her concentration was greatly diminished. She was not depressed but she was tired and slept four hours more each day.

I started her on niacin 500 mg tid, vitamin C 500 mg tid, folic acid 5 mg daily. Her serum copper was 130 milligrams percent (20.4 umol/ L) and her zinc was 92 (14.0). Two months later the only change was a slight gain in weight. After another six months her memory was worse. She had been started on an antidepressant by her family physician and this was discontinued at this visit. Instead I started her on aspirin 300 mg daily. Ten months after I first saw her she was better, perhaps ten percent. She was more alert.