Alzheimer's disease is a condition of gradually declining mental capacity with onset in the senium or pre-senium. This deinenting process is heralded by a progressive loss of memory for recent events. Clinical features include not only memory impairment but disorientation, decreased concentration, and often also anxiety, delusions, hallucinations, personality change, and neuromuscular disorders. A presumptive diagnosis of Alzheimer's disease is based on typical clinical and laboratory findings, but the diagnosis is definitive only with histologic confirmation of characteristic findings, such as senile plaques and neurofibrillary tangles. Etiology is unknown; various genetic, viral, toxic, and defective immune system theories have been advanced.This case depicts a patient with a presumptive diagnosis of Alzheimer's disease that began at 74 years of age. Her twin sister had a similar clinical picture beginning at age 68.