A 62-year-old man presents to his primary care physician with a lack of interest in life over the past months as well as trouble sleeping and being easily agitated or "set off." He appears anxious and unkempt and is incessantly tapping — first his foot and then his hand on his leg. He lost his wife of 40 years to breast cancer 1.5 years ago and has since sold the home in which they raised their three children to downsize to a more manageable property. He has a history of hypertension with varied control as well as high cholesterol for which he takes a statin. Physical exam revealed general lack of coordination and anomia.

The patient is diagnosed with frontotemporal dementia and is placed on citalopram and is referred for counseling and occupational therapy.

It is one year later: The patient returns at the prompting of his therapist, who has seen him every week. He is accompanied by his daughter and is exhibiting visuospatial dysfunction, short attention span and difficulty following the conversation, and a near inability to respond to simple questions. His daughter reports having to help him with both basic as well as instrumental tasks of daily living, including paying his bills. Laboratory tests are performed (complete blood count with differential, cobalamin, liver function test, thyroid stimulating hormone test, basic metabolic panel) to check for additional underlying causes. All tests come back in the normal range.