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

作者：Frydman Ilana; Ferreira Garcia Rafael; Borges Manuela C; Velakoulis Dennis; Walterfang Mark; Fontenelle Leonardo F^*

来源：Cognitive and Behavioral Neurology, 2010, 23(3): 205-208.

DOI：10.1097/WNN.0b013e3181e61ce0

• obsessive-compulsive disorder
• dementia
• frontotemporal dementia

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.

• 出版日期2010-9