This case report describes a 59-year-old female with a longstanding history of bipolar disorder (BD) who presented with rapid cognitive decline, including significant language deficits, apathy, and behavioral disinhibition. Neuroimaging revealed bilateral frontal atrophy and right parietal lesions, raising concerns about possible frontotemporal dementia (FTD) superimposed on her BD. Despite treatment adjustments, including switching from cariprazine to olanzapine and adding bupropion, cognitive and affective symptoms persisted, though some improvement in frontal lobe dysfunction was noted. The emergence of Parkinsonian symptoms, possibly exacerbated by olanzapine, further complicated the clinical picture. This case underscores the challenges of differentiating between psychiatric symptoms and neurodegenerative processes, emphasizing the need for ongoing monitoring, advanced imaging, and a tailored approach to management.
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