Institutional members access full text with Ovid®

Share this article on:

Dementia Developing in Late-onset and Treatment-refractory Obsessive-compulsive Disorder

Frydman, Ilana MD*; Ferreira-Garcia, Rafael MD*; Borges, Manuela C. PhD*; Velakoulis, Dennis MBBS, FRANZCP; Walterfang, Mark MBBS, FRANZCP; Fontenelle, Leonardo F. MD, PhD* † ‡

Cognitive and Behavioral Neurology: September 2010 - Volume 23 - Issue 3 - p 205-208
doi: 10.1097/WNN.0b013e3181e61ce0
Case Report

Background 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.

Objective To describe clinical outcomes in the 7-year follow-up of a patient with late-onset OCD.

Method Single case report.

Results 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.

Conclusion 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:

Received for publication December 5, 2009; accepted May 3, 2010

© 2010 Lippincott Williams & Wilkins, Inc.