This 60-year-old single male from home alone presented to psychiatric ward with presumed relapse of chronic psychotic illness. Pronounced apathy, amotivation, decreased self-care and changed eating habits. Absence of positive psychotic symptoms or thought disorder other than poverty of thought. Similar past presentation ten years prior which had rapidly developed to mutism and no oral intake; treated with ECT. Detailed history revealed that the recent presentation was different with altered eating habits (eating inappropriate foods such as large quantities of sweet foods as a meal) rather than reduced oral intake. Neurological examination revealed extra-pyramidal rigidity in keeping with antipsychotic medication and frontal release signs (positive glabellar tap, palmomental and grasp reflexes).

MRI brain scan completed which showed marked atrophy of frontal and parietal lobes, particularly on the left. Subsequent SPECT and FDG-PET revealed marked hypoperfusion of frontal and temporal lobes, consistent with bvFTD.

This patient met criteria for "probable bvFTD" as per the international consensus criteria on behavioral variant fronto-temporal dementia.