Marked Fluctuations in Medicine / Internal Medicine — 63yo Man | Psychiatry | SMLE Q#16976
SMLE Question #16976
Medicine / Internal Medicine
Psychiatry
Objective: OBJ-253
Last updated: February 2026
A 63-year-old man has 2 years of progressive cognitive decline with marked fluctuations in attention. He has recurrent well-formed visual hallucinations and a parkinsonian gait. He is oriented to person but often disoriented to place and time. Donepezil was started recently with modest improvement in attention and memory, but hallucinations with agitation remain distressing. Neurologic examination shows mild rigidity and bradykinesia without tremor. There is no substance use or prior primary psychotic disorder. What is the most appropriate medication to add?
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