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Here, we describe detailed clinical and pathological features of a case carrying the P301L tau mutation that showed only apathy until the middle stage of the course. The mother of this case was suspected to have mild cognitive decline at age 46. However, before she was fully examined, she had a subarachnoid hemorrhage at age 49 and died at age 53. An autopsy was not done. The proband of this pedigree, a 60\u2010year\u2010old right\u2010handed Japanese man at the time of death, began to make mistakes at work at the age of 51\u2009years. Until age 54, he showed only mild apathy with bradykinesia. Insight was well spared. Parkinsonism and echolalia developed at age 55, and pyramidal signs and oral tendency at age 57. Personality change, disinhibition, stereotypy, or semantic memory impairment was not found throughout the course. The final neurological diagnosis was unspecified dementia. Pathological examination demonstrated numerous round four\u2010repeat tau\u2010positive three\u2010repeat tau\u2010negative or perinuclear ring\u2010like neuronal cytoplasmic inclusions with many ballooned neurons in the frontal and temporal cortices and hippocampus. Genetic analysis using frozen brain tissue demonstrated a P301L tau mutation. Among 31 previously reported cases bearing the P301L tau mutation for which the data regarding initial symptoms are available, one clinical case showed only apathy with depression in the early stage. Given these findings, clinicians should be aware that a clinical course characterized only by apathy for several years, which can be misdiagnosed as a psychiatric disorder, is one of the clinical presentations associated with P301L tau mutation.<\/jats:p>","DOI":"10.1111\/neup.12441","type":"journal-article","created":{"date-parts":[[2017,11,6]],"date-time":"2017-11-06T09:32:48Z","timestamp":1509960768000},"page":"268-280","source":"Crossref","is-referenced-by-count":9,"title":["Frontotemporal lobar degeneration due to P301L tau mutation showing apathy and severe frontal atrophy but lacking other behavioral changes: A case report and literature review"],"prefix":"10.1111","volume":"38","author":[{"given":"Tomoko","family":"Miki","sequence":"first","affiliation":[{"name":"Department of Neuropsychiatry Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences  Okayama Japan"},{"name":"Department of Psychiatry Kinoko Espoir Hospital  Okayama 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