Biaggi_2025_Cureus_17_e80482

The emergence of psychiatric symptoms in late life presents a diagnostic challenge due to their overlap with neurodegenerative disorders. This case details a 66-year-old male with acute psychosis, initially raising concerns for an underlying neurodegenerative-related process. Comprehensive evaluation, including neuroimaging and laboratory studies, excluded neurodegeneration, leading to a diagnosis of very late-onset schizophrenia. The patient demonstrated clinical improvement with an atypical antipsychotic, while an acetylcholinesterase inhibitor was discontinued due to the absence of neurodegenerative pathology. This case highlights the critical role of thorough diagnostic assessment in differentiating primary psychiatric disorders from neurodegenerative conditions in older adults.