This 51-year-old right-handed woman requested further care for her previously diagnosed Alzheimer disease. Over the previous year, her coworkers observed that she would frequently forget instructions and conversations and increasingly relied on written reminders. She would ask the same question repeatedly and cueing helped inconsistently. Her symptoms had not worsened since. There were no language or visuospatial impairments. Her past medical history included lumpectomy and tamoxifen for breast cancer five years ago, and a 30-year history of alcohol abuse (daily beer and vodka, unknown volume). Indeed, family members reported finding empty bottles of vodka in the garbage. She had no family history of cognitive impairment or other neurologic condition. Previous work up included a normal blood work, brain MRI with contrast, normal cell count, protein, glucose, and cytology in cerebrospinal fluid, but bilateral temporoparietal hypometabolism on FDG-PET (Figure 35.1). With a presumed diagnosis of Alzheimer disease, she was started on donepezil 5 mg daily.