A 53-year-old, right-handed man with 14-years of education presented with a 1-year history of progressive neuropsychiatric changes. He became disinhibited in conversation and in approaching strangers, unempathic in his response to friends and family, compulsive in making 10–20 phone calls per day and calling 800- numbers, and apathetic and disengaged from productive activities. He also developed an inordinate “sweet tooth,” with a preference for strawberry milkshakes. The past medical history and family histories were nonsignificant. Along with these changes, the patient struggled to find the right word to use and began to misuse words. When asked about the name of the clinic, he replied “phallic” instead of “neurologic,” but could not explain why. He states that he was making “innuendos” for errors. He described his problem as a “medieval condition,” and he pointed to his head. Later, he said that he had a “molecular problem” that affected his thinking. The patient described himself as very “aesthetic” and “coexistent.” He made multiple other word substitutions throughout the interview. On examination, he had word-finding difficulty and decreased words per minute. On the Mini-Mental State Exam, he scored 21/30. He generated 11 animals/minute and 6 “F” words/minute, with frequent perseverations. On the 15-item Mini-Boston Naming Test, he named 11 items. On 10-word list learning, he recalled only 1, but recognized all 10. His visuospatial constructions were normal, but he was concrete on proverb interpretation and made errors on reciprocal programs. The rest of his neurological examination was normal. MRI was within normal limits, but positron emission tomography showed marked bifrontal and mild bitemporal hypometabolism, left greater than right, consistent with FTD. Management included 0.5 mg risperidone and 75 mg sertraline, resulting in a decrease in his compulsive behaviors.