Although several studies have been conducted in an attempt to characterize the phenotype and underlying pathophysiology of individuals with early-onset obsessive-compulsive disorder (OCD), the literature on patients who develop OCD later in life remains sparse.
To describe clinical outcomes in the 7-year follow-up of a patient with late-onset OCD.
Single case report.
A 64-year-old woman exhibiting a 7-year history of treatment-refractory late-onset OCD developed significant cognitive deterioration. We suggest that the association between late-onset treatment refractory OCD and dementia may stem from at least 3 different scenarios. First, dementia may be an inexorable end-point of some forms of malignant, primary, and late-onset obsessional illness. Second, late-onset OCD and dementia may result from a common pathophysiologic basis, such as in fronto-temporal dementia. Finally, the association between both conditions may result by the interaction between vulnerability toward OCD-type symptoms and the nonspecific effects of a neurodegenerative process. In our case, although subclinical OCD was likely to be “unmasked” by cognitive decline and/or bilateral caudate vascular lesions, ensuing cognitive deterioration could be ascribed to development of Alzheimer dementia.
Our observation suggests that treatment refractoriness in an individual with late-onset OCD may indicate underlining organicity.
*Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal of Rio de Janeiro, Rio de Janeiro
‡Department of Psychiatry and Mental Health, Universidade Federal Fluminense, Niterói, RJ, Brazil
†Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia
Leonardo F. Fontenelle was supported by an Endeavour Research Fellowship (Postdoctoral Research) from the Australia Government's Department of Education, Employment, and Workplace. Reprints: Leonardo F. Fontenelle, MD, PhD, Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal of Rio de Janeiro, Rua Visconde de Pirajá 547, sala 323, Ipanema, Rio de Janeiro-RJ, CEP: 22410-003, Brazil (e-mail: firstname.lastname@example.org).
Received for publication December 5, 2009; accepted May 3, 2010