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This interesting case report illustrates a paraneoplastic syndrome presenting as dementia. A 75-year-old Malaysian lady with a 45-pack year smoking history presented with unintentional weight loss of three stone in three months with generalised aches and pains and short-term memory problems. Her inflammatory markers were raised, liver function tests were deranged, and her thyroid stimulating hormone was low. Cerebrospinal fluid examination revealed a mild increase in protein. On the Addenbrookes Cognitive Scale her score was 39/100 and she also had clinical features to suggest mild depression. A Computed Tomography of the thorax showed a 34mm mass anterior to the trachea and an enlarged right para-tracheal lymph node. Subsequent endo-bronchial ultrasound biopsy confirmed metastatic small-cell lung cancer. She had positive autoantibodies for anti-Hu and anti-Sox 1; indicating a paraneoplastic syndrome or limbic encephalitis. Paraneoplastic syndromes are rare and difficult to diagnose. In this case, the paraneoplastic manifestations mimicked a dementia illness.