Abstract Objective Studies have established a relationship between earlier-onset (< 40 years of age) and late-onset (between 40 and 60 years of age) psychosis symptoms on cognitive functioning, but little is known about the neurocognitive profile of very-late-onset psychosis (≥60 years of age) (Sharma et al., 2014; Howard et al., 2000). This case highlights the neuropsychological profile in an older adult with very-late-onset psychosis. Method 84-year-old, right-handed, Caucasian female with no significant medical or psychiatric history prior to 2013. Onset of delusions, paranoia, and tactile, auditory, and visual hallucinations initially beginning in 2013 with no identifiable trigger and worsening symptoms in 2018. Labs within normal limits and urine drug screen was negative. Results Her estimated premorbid verbal functioning fell within the average range which fell slightly below her score as predicted by her demographic history (i.e., education, occupation, region, sex, and race/ethnicity), which fell within the high average range. Her overall objective testing indicated that she demonstrated relative weaknesses encoding increasingly complex auditory and visual information and reliably retrieving the information from her long-term memory on command. She demonstrated intact orientation, impaired performance on a cognitive switching task, and a visuospatial task. Conclusions The patient demonstrated grossly intact performance across many cognitive domains. This paradox highlights the need for further investigation of the neuroanatomical correlates of psychosis in older-adults and its longitudinal neurocognitive profile as often, individuals are presumed to be suffering from a neurodegenerative disorder such as Alzheimer’s type dementia or Dementia with Lewy bodies (Assche et al., 2018).