ne-01 · Student

Mrs Kaur: forgetful since the spring

The case (fictional)

Mrs Harjit Kaur is 74 and lives with her son's family in west London. She speaks Punjabi and a little English. She went to school for five years in Punjab and has never read English. Her daughter-in-law brings her to a memory clinic.

Over five months Mrs Kaur has become forgetful: she repeats questions, misplaces things and has stopped cooking, which she used to love. Her husband died eight months ago. She cries often, says "What use am I now?", sleeps poorly and eats little.

Last week she was suddenly very confused at night, picking at the bedsheets and talking to her late husband as if he were in the room. This settled over two days. Around the same time she had been complaining of burning when passing urine. She takes tablets for blood pressure, and recently started an over-the-counter sleeping tablet that contains an antihistamine.

Her hearing is poor and she has refused hearing aids. A brief cognitive test was done last month in English, with her grandson translating. She scored well below the usual cut-off.

Identify differential diagnoses and what you would assess next

List the differential diagnoses or contributing factors for Mrs Kaur's memory problems, with reasons, and say what you would do or assess next.