A 76-year old white married female had rapid onset dementia with myoclonus and was admitted to an HMO hospital where she was initially diagnosed as Alzheimer's disease. The physicianhusband suggested that the condition might be due to the Pepto-Bismol which she had taken chronically to control her irritable bowel syndrome. An elevated serum bismuth level of 242 μg/L (normal is 5 μg/L) established bismuth toxicity as the cause of the dementia. With treatment the patient returned to a normal

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... l state. The possibility of bismuth encephalopathy needs to be considered in the differential diagnosis of possible Alzheimer's dementia.