Early-onset frontotemporal dementia misdiagnosed as psychosis: a case from rural Nepal

Background: Early-onset behavioral variant frontotemporal dementia (bvFTD) is a neurodegenerative disorder characterized by prominent behavioral and personality changes and is frequently misdiagnosed as a primary psychiatric illness, particularly in low-resource settings, leading to diagnostic delays and inappropriate treatment. Materials and methods: We report the case of a 36-year-old man from rural Nepal with an 18-month history of progressive behavioral changes. Clinical history, longitudinal symptom progression, treatment response, family history, and neuroimaging findings were evaluated to establish the diagnosis. Results: The patient developed progressive disinhibition, hyperorality, impaired judgment, executive dysfunction, and cognitive decline. He was repeatedly treated for psychosis and substance-related disorders without sustained improvement. Further evaluation revealed a positive family history of early-onset behavioral illness and neuroimaging demonstrating bilateral frontal and temporal lobe atrophy, supporting a diagnosis of possible bvFTD. Conclusion: This case highlights the importance of considering frontotemporal dementia in young patients presenting with atypical or treatment-resistant behavioral syndromes to reduce diagnostic delay and improve patient and caregiver outcomes.