4.9.4 ‘System menu appears on ALT-Space’
If this option is enabled, then pressing ALT-Space will bring up the PuTTY window's menu, like clicking on the top left corner. If it is disabled, then pressing ALT-Space will just send ESC SPACE to the server.
Some accessibility programs for Windows may need this option enabling to be able to control PuTTY's window successfully. For instance, Dragon NaturallySpeaking requires it both to open the system menu via voice, and to close, minimise, maximise and restore the window.