title: Dementia developing in late-onset and treatment-refractory obsessive-compulsive disorder.
abstract: 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.
authors.affiliation: Anxiety and Depression Research Program, Institute of Psychiatry, Universidade Federal of Rio de Janeiro, Ipanema, Rio de Janeiro, RJ, Brazil.
authors.forename: Ilana
authors.initials: I
authors.lastname: Frydman
authors.forename: Rafael
authors.initials: R
authors.lastname: Ferreira-Garcia
authors.forename: Manuela C
authors.initials: MC
authors.lastname: Borges
authors.forename: Dennis
authors.initials: D
authors.lastname: Velakoulis
authors.forename: Mark
authors.initials: M
authors.lastname: Walterfang
authors.forename: Leonardo F
authors.initials: LF
authors.lastname: Fontenelle
mesh_terms: 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
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors