Idiopathic basal ganglia calcification, also known as Fahr’s disease, is a rare neurological disorder characterized by abnormal calcium deposition in basal ganglia and cerebellum, usually associated with neuropsychiatric symptoms and movement disorders. The same diagnostic label probably encompasses different diseases with variable characteristics. Here we report 4 patients who meet criteria for Fahr’s disease, presenting different radiological, neuropsychological, psychiatric, and systemic features, to assess the role of cerebral calcifications in the clinical picture. All patients underwent complete neuropsychological evaluations at our unit. Cerebral computed tomography scans were obtained for all patients, and magnetic resonance images were also available for patients 1, 2, and 4. Patients presented heterogeneous radiological and neuropsychological features; overall clinical pictures varied from completely asymptomatic to severe cognitive impairment. In our patients, the site and extent of brain calcification appear only partially indicative of clinical severity because the worsening of brain calcifications does not lead to a corresponding clinical worsening.