Maniform Presentation of Behavioral Variant Frontotemporal Dementia Mimicking Late-Onset Mania: A Diagnostic Challenge

Frontotemporal dementia (FTD) is a neurodegenerative disorder that may initially present with behavioral and affective symptoms, often mimicking primary psychiatric conditions, such as bipolar disorder, leading to frequent misdiagnosis.We report the case of a 70-year-old woman with no prior psychiatric history who presented with a first episode of maniform behavior, characterized by euphoria, disinhibition, decreased need for sleep, impulsive spending, and socially inappropriate conduct, mimicking late-onset bipolar disorder.Neuropsychological evaluation revealed significant executive dysfunction.Brain magnetic resonance imaging demonstrated bilateral frontal and anterior temporal lobe atrophy consistent with behavioral variant FTD (bvFTD).This case highlights the diagnostic challenge of distinguishing late-onset manic syndromes from neurodegenerative disease.It underscores the importance of integrating clinical history, cognitive assessment, and neuroimaging to improve diagnostic accuracy and avoid misdiagnosis.