Introduction: Grief may be complicated in patients with dementia, posing a challenge to caregivers and healthcare professionals. A case of major vascular neurocognitive disorder with pathological jealousy and major depressive disorder in grief is reported. Case: A 73 year-old Malay lady with diabetes mellitus, hypertension, dyslipidemia, and right cerebrovascular accident developed major vascular neurocognitive disorder with pathological jealousy and major depressive disorder. She presented with unmanageable agitation and depression after her late husband’s death. She also experienced a bizarre delusion of her husband’s resurrection and infidelity. Her psychotropic medications were optimised and her bizarre delusion was challenged daily using validation and distraction techniques. Combined pharmacotherapy and behavioural therapy managed to resolve her psychiatric symptoms and facilitate her grief process. Conclusion: Grief reaction in major vascular neurocognitive disorder patients is often atypical. Individualized treatment comprising both pharmacotherapy and behavioural therapy should be offered to treat atypical grief and the underlying disease.