A 58-year-old man had to give up his weekly swimming club as gradually he could no longer keep up with his peers and had difficulty climbing out of the water. He had always been a keen hiker, but for the past four years had to shorten the distance. His body weight increased. Six months prior to referral he sprained his ankle after stumbling over a threshold. In the dark, he had difficulty finding his way to avoid falling. He tended to choke when drinking a cup of tea. His mother’s deceased brother had become wheelchair dependent after retiring.