Parkinson disease and dementia with Lewy bodies Quiz: Ace Your Exams

A 71-year-old man presents to the primary care clinic with his partner for evaluation of frequent falls. Over the past two years, the patient has become increasingly clumsy, and his partner has noticed their evening walks take longer. The patient’s partner has noticed episodes of inattention, and it seems like the patient misjudges distances and gets lost when driving. Over the past six months, increased vocalizations and movements during sleep have been noted. Past medical history is notable for hypertension, hyperlipidemia, and gastroesophageal reflux disease, for which the patient takes lisinopril, simvastatin, and omeprazole. Temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 14/min, and blood pressure is 130/80 mmHg. On exam, the patient has a flattened affect and is intermittently drowsy. Movements are slow, and there is a pill-rolling tremor of the right hand at rest. Which of the following additional findings on history would be most supportive of the diagnosis?