A 68-Year-Old Man Is Brought to the Emergency Department by His

A 68-year-old man is brought to the emergency department by his daughter due to a change in mental status.  Over the past 2 days, the patient has reported seeing strangers sneaking around the house when only he and his daughter were at home.  He has also been intermittently confused, difficult to rouse, and distractible.  The patient has had no headaches or focal weakness.  He has no chronic medical or psychiatric problems other than seasonal allergies, which his daughter says have flared up since he moved in with her 2 weeks ago.  Temperature is 36.7 C (98 F) , blood pressure is 140/85 mm Hg, pulse is 88/min, and respirations are 12/min.  On physical examination, the patient is somnolent but arousable to voice.  He is not oriented to place or time.  Pupils are bilaterally equal and reactive to light.  Bilateral upper and lower extremity muscle strength, deep tendon reflexes, and pain sensation are normal.  Blood cell counts and serum chemistry studies are within normal limits.  Which of the following is the most likely cause of his current condition?

A) Brief psychotic disorder
B) Dementia with Lewy bodies
C) Frontotemporal dementia
D) Hypothyroidism
E) Medication effect

Correct Answer:

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