CASE PRESENTATION An 86-year-old man was referred to the movement disorders clinic for evaluation of progressive gait and balance impairment leading to restriction in his activities. The gait impairment had begun gradually 1 year before and had progressed insidiously. Upper extremity function was preserved. He had pain in the back and left knee for which he took analgesics. Memory loss and problem-solving difficulties, noted by family members, impaired instrumental activities of daily living. Cognitive decline had progressed along with the gait impairment. There was occasional freezing. The patient was also more irritable and talked about dying. He had some urinary urgency. He had smoked for 70 years and drank two alcoholic beverages a day. His only medication was occasional oxycodone. He had a history of a lumbar laminectomy and enucleation of one eye.