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This case report describes a lady who developed sudden onset of speech disturbances mimicking thought disorders of primary psychotic disorder after 9 month of apparently improved right sided hemiplegia following an event of cerebro-vascular accident about one year back with no particular cause evident on routine investigations. A 63-year-old woman presented with chief complaints of irrelevant answers, at times incomprehensible speech and talking nonsense. Presently problems created the diagnostic dilemma between primary psychotic disorder predominantly with formal thought disorder and Wernicke's aphasia, in the absence of any apparent underlying neurological causes. The authors discuss the differentiating features for making correct diagnosis in accord with the ICD-10, Classification of Mental and Behavioral Disorders, Clinical descriptions and diagnostic guidelines, World Health Organization (ICD-I0) criteria, and a behavioral technique as the possible treatment option with beneficial outcome for Wernicke's aphasia, which comprised of audio-visual stimulus and reviewed the importance of considering this diagnosis in the setting of neuropsychiatric symptoms in the elderly and reported on a 63-year-old female with Wernicke aphasia mimicking formal thought disorder of psychosis. [ABSTRACT FROM AUTHOR]