A 67-year-old male presents with his wife, who reports that for the past 2 years he has been physically acting out his dreams during sleep — punching, kicking, shouting, and once falling out of bed and injuring his shoulder. Polysomnography confirms REM sleep without atonia with dream-enacting behaviors. His neurological examination is currently normal, but the PMHNP notes a mildly reduced sense of smell on olfactory testing and occasional constipation. He has no psychiatric history and no history of medication or substance use that could explain the findings.