Diogenes syndrome in dementia: a case report

Abstract

Background Diogenes syndrome is a neurobehavioural syndrome characterised by domestic squalor, hoarding and lack of insight. It is an uncommon but high-mortality condition, often associated with dementia. Aims To describe the clinical features and treatment of Diogenes syndrome secondary to behavioural variant frontotemporal dementia (bvFTD). Method We describe a case of bvFTD in a 77-year-old man presenting with Diogenes syndrome. Results The patient's medical and psychiatric histories were unremarkable, but in recent years he had begun packing his flat with ‘art pieces’. Mental state examination revealed confabulation and more structured delusions. Neuropsychological evaluation outlined an impairment in selective attention and letter verbal fluency, but no semantic impairment, in the context of an overall preserved mental functioning. Brain magnetic resonance imaging and positron emission tomography (PET) with fluorodeoxyglucose showed mild bilateral temporo-insular atrophy and hypometabolism in the left-superior temporal gyrus respectively. An amyloid PET scan and genetic analysis covering the dementia spectrum were normal. A diagnosis of bvFTD was made. Conclusions The clinical framing of behavioural symptoms of dementia such as hoarding poses a diagnostic challenge. This case illustrates the importance of a deeper understanding of Diogenes syndrome, leading to timelier diagnosis and effective therapeutic strategies.

Diogenes syndrome - causes and treatment of pathological hoarding and self neglect

“…The average age of a person with Diogenes syndrome is 79 [1,14]. They are mostly single, although rare cases have been described in married couples or siblings -the socalled "Diogenes à deux" [1,2,14].…”

“…Diogenes syndrome is a neuropsychiatric condition characterized by pathological hoarding, extreme neglect of oneself and surroundings, poverty, and lack of insight, which makes it impossible to seek for help [1,2]. The term refers to a Greek philosopher who rejected average functioning in society and chose destitution [3].…”

Demencia frontotemporal – variante conductual como diagnóstico diferencial de trastornos psiquiátricos primarios

“…Entre los diversos tipos de demencia, el síndrome de Diógenes parece tener una importante relación con la DFTvc, en la que se ha hallado hasta en un 36% de casos: esto puede sustentarse a partir de la presentación de conductas compulsivas, de forma acumulativa, y el descuido de la propia higiene personal. Sin embargo, los pacientes no muestran mayor interés en los objetos que han acumulado e incluso pueden permitir que otros los eliminen sin enfrentar mayor afectación (64). Lo que motiva la conducta de acumulación patológica en los pacientes con DFTvc vendría a ser la orientación predominante de la DFTvc a los estímulos del exterior, que a su vez activa conductas de manipulación y agrupación (63).…”

“…Lo que motiva la conducta de acumulación patológica en los pacientes con DFTvc vendría a ser la orientación predominante de la DFTvc a los estímulos del exterior, que a su vez activa conductas de manipulación y agrupación (63). Es importante la detección y reconocimiento adecuado del síndrome de Diógenes pues se asocia a importante comorbilidad y mortalidad elevada (46% a 5 años de seguimiento) (64).…”

Sexual Sadism Towards a Minor and Diogenes Syndrome With the Hiding of a Cadaver

“…Diogenes syndrome (named after the Greek philosopher and cynic), is a neurobehavioral syndrome characterized by severe neglect and domestic misery, pathological accumulation of waste or garbage, compulsive hoarding, lack of shame with respect to healthy and/or hygienic living conditions and denial of the disease (anosognosia); the latter being that which prevents most of this type of people from seeking medical and/or psychological help [8,9] The syndrome has been described mainly in the elderly, although there are some cases in the literature in younger people.…”