This 76-year-old right-handed man with an amnestic presentation, suspicious for Alzheimer disease and diagnosed 5 years earlier, returned to the clinic for follow-up. Although he initially experienced improvement with donepezil, his cognition progressively declined over the following three years. In the last six months, his wife, who was his primary caregiver, noted that he was more forgetful and repetitive. However, now when he misplaced objects (e.g., wallet, books), he became convinced that the lost objects were stolen, even when the missing items were found and shown to him. Her repeated attempts to reassure him that the objects were merely misplaced triggered agitation and confusion. No threatened or real physical aggression ensued. In the office, he had no recollection of the events. He was oriented to place and person. His speech was fluent and his discourse was circumlocutory. The remainder of the exam was unremarkable.