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A 77-Year-Old Woman Is Brought to the Office by Her

question 338

Multiple Choice

A 77-year-old woman is brought to the office by her husband due to memory impairment and increasingly bizarre nighttime behavior over the last year. The patient stopped driving last year as she frequently became lost in familiar neighborhoods. She can no longer cook without supervision as she occasionally forgets to turn off the burner. The patient has said she sees a man outside her window at night, but her husband has never found anyone there. She has also begun to vocalize in her sleep; more recently, she has kicked and punched her husband while sleeping. The patient has become increasingly distractible and sometimes stops responding mid-conversation for brief periods.
Blood pressure is 122/78 mm Hg supine and 98/68 mm Hg standing. Pulse is 64/min supine and 85/min standing. Physical examination is significant for very mild bilateral limb rigidity in the upper extremities on passive range of motion, which the patient does not find bothersome. Gait is somewhat slowed; the patient's husband reports that she has fallen more than once. She scores 21 out of 30 on the Montreal Cognitive Assessment.
Which of the following is the most likely diagnosis?

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Definitions:

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