Aripiprazole is a novel atypical antipsychotic agent with unique pharmacological profiles as a partial dopamine receptor agonist. Few extrapyramidal signs have been reported previously following the use of aripiprazole. In the present study, we report on an 84-year-old female patient who suffered from vascular dementia with psychotic symptoms. She was treated with aripiprazole and acute dystonia was noted. This case report highlights the importance of slow titration of aripiprazole and close monitoring for extrapyramidal signs in elderly psychotic patients with vascular dementia.