Dementia developing in late-onset and treatment-refractory obsessive-compulsive disorder.
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.


METHODS
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.


CONCLUSIONS
Our observation suggests that treatment refractoriness in an individual with late-onset OCD may indicate underlining organicity.
Frydman
Ilana
I
Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal of Rio de Janeiro, Ipanema, Rio de Janeiro, RJ, Brazil.
Ferreira-Garcia
Rafael
R
Borges
Manuela C
MC
Velakoulis
Dennis
D
Walterfang
Mark
M
Fontenelle
Leonardo F
LF
D000367:Age Factors; D003704:Dementia / Q000150:complications* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009483:Neuropsychological Tests; D009771:Obsessive-Compulsive Disorder / Q000150:complications* / Q000188:drug therapy / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D017211:Treatment Failure
D017367:Selective Serotonin Reuptake Inhibitors