Dementia with Lewy bodies Quiz: Ace Your Exams

A 65-year-old man comes to the office escorted by his partner due to recent falls and confusion. Additionally, the partner states that multiple times throughout the night, the patient exhibits various movements in his sleep, such as throwing a ball and even accidentally kicking her one night. The patient states he is unaware of these activities, but he describes vivid dreams of playing football or fighting off home invaders. The patient’s partner mentions that the symptoms began a year ago, and since then, they have been getting worse, although some days are better than others. Medical history is unremarkable. Vitals are within normal limits. Physical examination reveals muscle rigidity in the upper extremities, and the patient walks slowly with small steps. On Mini-Mental State Examination the patient has difficulty with copying overlapping pentagons and drawing a clock but can repeat 3 objects after 1 and 5 minutes respectively. Which of the following is the most likely diagnosis?