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.