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A 51-year-old man was referred for neurologic consultation because of increasing forgetfulness, difficulty walking, frequent falls, apathy, and decreased motivation to perform activities of daily living such as bathing, cooking, and driving, over a 6-month period. He had a history of Crohn disease (CD), diabetes, and coronary artery disease. Current medications included amlodipine, rosiglitazone, hydrochlorothiazide, and budesonide. He was treated with oral prednisone for CD in the past with excellent response. Two years before evaluation, he developed multiple side-effects including weight gain, edema, and hypertension that precluded the use of prednisone. Nine months prior to his presentation, he was started on oral budesonide at 9 mg/day. He tolerated the new medication well and had none of the side-effects previously noted. However, he experienced a relapse of his CD 6 weeks after an attempt was made to discontinue budesonide, and the medication was restarted.
On initial examination, he had a Mini-Mental State Examination (MMSE) score …
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