We present a patient who, based on the finding of markedly elevated serum arsenic (As) and aluminum (Al) in hair and nail clippings, was thought to have an organic brain syndrome and affective disorder. Autopsy evaluation revealed definite Alzheimer's disease (AD).Numerous studies have suggested a role for As, Al, lead (Pb), cadmium (Cd) and mercury (Hg) in the pathogenesis of AD but none have been convincingly implicated in the development of AD, particularly if the exposure is in adults. Largely unreported, is the effects of extremely high levels of all of these metals in one patient.We report a patient with a unique history of variable exposures over approximately 33 years to As (5011 × Nl), Al (84 × Nl), Pb (4.6 × NL ), Cd (3.8 × Nl), Hg (4.6) who was thought to have organic brain syndrome but at autopsy was found to have severe AD. The literature of metal dyshomeostasis and AD is briefly reviewed.