A Startling Decline: You Diagnose the Condition using an Interactive Medical Case

N Engl J Med 2012; 366:836-842 March 1, 2012

A Startling Decline

Mikael L. Rinne, M.D., Ph.D., Scott M. McGinnis, M.D., Martin A. Samuels, M.D., Joel T. Katz, M.D., and Joseph Loscalzo, M.D., Ph.D.


In the New England Journal of Medicine feature, information about a real patient is presented in stages to an expert clinician, who responds to the information, sharing his or her reasoning with the reader. The authors’ commentary follows.

An 89-year-old man was brought to the emergency department by his wife and son for an evaluation of changes in cognition and personality. Six months earlier, he began to require help managing finances and operating his computer. He had poor memory for recent events, had difficulty expressing himself, and had become increasingly irritable. He also exhibited unusual behaviors, such as eating a banana peel, pouring milk onto the table, and undressing immediately after getting dressed. He began to have difficulty walking and occasional urinary and fecal incontinence. During the course of several months, he became unable to dress, bathe, . . .

You Diagnose the Condition using an Interactive Medical Case here:  http://www.nejm.org/doi/full/10.1056/NEJMimc1109704