A 38-year-old man presents with involuntary facial grimacing, shrugging of the shoulders, and jerking movements of the limb. His father was similarly affected. There is also a history of mood changes for the past 3 months. On examination, he appears restless with intermittent slow movements of his hands and face. He has difficulty performing rapid finger movements, and tone is decreased in the upper and lower limbs. Which of the following is most likely to represent the progression of his illness?