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Clinical Focus
13 FEBRUARY 2026 ausdoc. com. au
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A patient passes the time making fishing sinkers and model steam engines, but his hobbies ultimately expose the cause of his mysterious memory loss.
Dr Maxy Mariasegaram GP in Melbourne, Victoria.
ANDY, a 52-year-old laboratory manager, presents with a sixmonth history of worsening memory and short-term recall problems. He also reports dizziness and occasional left leg weakness.
At his worst, he has needed frequent reminders from his wife, Jen, to complete day-to-day tasks, and his work has been so significantly impacted that he has had to take time off. His mood and sleep have not been affected, although he has been uncharacteristically snappy recently. Systems review is otherwise unremarkable.
His medical history includes type 2 diabetes, hypertension and gastrooesophageal reflux disease, which are usually controlled with metformin – empagliflozin, ramipril and esomeprazole.
On examination, Andy’ s vital signs are within normal limits and stable, his BMI is 21.9kg / m2, blood pressure is 129 / 90mmHg and pulse is 71bpm and regular. Neurological examination is unremarkable.
Andy’ s GP refers him for pathology and a CT brain. The blood tests reveal that Andy’ s diabetes control is not to target, with a HbA1c of 8.2 %( target: below 7 %) and a fasting BSL of 9.7mmol. L( normal: 3-5.4). The remaining blood test results— including FBC, EUC, LFT, thyroid function test, HIV, syphilis, CRP, MSU and fasting cholesterol— are all normal. CT brain is also normal, with no evidence of ischaemia, infarction or space-occupying lesion.
When Andy attends with Jen for his results, she mentions that, while off work, he has been keeping busy engaging more in his hobby of making lead sinkers for fishing and restoring antique pewter model steam engines. This prompts the GP to add a serum lead level to the initial pathology, which is elevated at 1 μg / dL( normal: below 0.5 µ mol / L).
The GP suspects chronic lead exposure, complicated by poorly controlled diabetes, as the likely cause of Andy’ s symptoms.
Discussion
Mild cognitive decline can stem from various causes, including neurodegenerative, metabolic and vascular conditions. However, environmental toxins, such as lead, are often overlooked contributors. This case highlights how easily it can occur, with chronic low-level
lead exposure through an innocuous hobby ultimately proving to be a key factor contributing to cognitive impairment. Poorly controlled diabetes is also likely a contributing factor to his cognitive symptoms.
Exposure to this toxic metal can have adverse effects on multiple systems via multiple biochemical mechanisms. Some of these are reversible if lead poisoning is identified and managed early. However, acute high-level
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