This 67-year-old right-handed woman presented with a 2-year history of tremor and gait difficulties followed by cognitive impairment. The rest tremor appeared two years before her initial exam, followed six months later by falls and slow gait. Over the last year, she noticed difficulty maintaining her focus and frequently lost her train of thought. Word-finding impairment with frequent word substitutions emerged in addition to difficulties operating household appliances (e.g., remote control), which were not attributed to motor deficits. Her sister noticed she was forgetful and repetitive. She had experienced depression since age 17, currently managed with paroxetine 50 mg and amitriptyline 200 mg daily. In addition, she was on diazepam 10 mg daily for anxiety and zolpidem 10 mg at bedtime as a sleeping aid. On exam, she exhibited asymmetric resting tremor, bradykinesia, and rigidity. Her gait was slow with decreased stride length and impaired postural reflexes.