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Of course he was pious, maybe even disconcertingly so, his wife reasoned at first. He was a pastor. But over the years, certain behaviors became more extreme, and thus harder to explain away. For one, the 60-year-old North Carolina man refused to tolerate questions about certain passages that contradicted his own interpretations; meanwhile, his congregation shrank, no doubt as a result of his increasingly odd behavior.

This turned out to be a strange case of pathological piety, and the man’s medical team recently published his case study in the journal The Clinical Neuropsychologist. As science writer Agata Blaszczak Boxe at Brain Decoder notes, what began as an apparent case of “hyperreligiosity” in the end turned out to be an unusual symptom of an atrophying brain.

The Problem: At first it just seemed like his memory was getting a little worse, as he started forgetting more names than usual. And then came the “excessive piety,” as the authors phrase it in their paper:

The patient’s wife reported he had become more ‘obsessive’ in some of his thinking and more adamant about some of his beliefs, particularly with regard to religion. For example, whereas he was previously open to some discussion about certain biblical passages that are commonly viewed as ambiguous within the Christian community, he was now insistent on his interpretation.

This behavior got worse over time, and as a consequence his congregation grew smaller and smaller:

More specifically, the patient was moved to Pastor progressively smaller congregations over a period of 10 years, in part secondary to having interpersonal difficulty with managing a church body as well as the noteworthy increase in piety.

Beyond the unusual behavior regarding religion, his wife noticed other changes in personality, too, describing his behavior as “overly disinhibited”: He’d approach total strangers and spill personal, intimate details regarding the health and finances of their family, including the grandchildren. The patient himself, however, refused to admit to any changes in his behavior or cognitive function.

The Diagnosis: A series of examinations revealed that the pastor’s increasingly odd behavior was likely a sign of frontotemporal dementia, which is associated with atrophy — that is, a wasting-away — of the brain’s right temporal lobe. This type of brain atrophy is often accompanied by changes in personality, such as “behavioral rigidity, obsessive-compulsiveness (in regards to daily routine),” and social disinhibition, his physicians write in their paper.

Unfortunately, there are limited treatment options for this condition, and the paper ends without a clear explanation of what happened to the pastor and his wife. But they do note that unusual cases like these help find more clues, to possibly help more patients in the future.