An 81-year-old female with no previous psychiatric history presented with late-onset obsessive compulsive disorder following an acute right macular hemorrhage and loss of vision. Following a thorough organic screen to exclude a physical cause, various high doses of selective serotonin reuptake inhibitors were tried with no therapeutic benefit. The patient had significant remission of her symptoms following a course of electroconvulsive therapy.

In this study, we assess the neuropsychological profiles of both early and late symptom-onset obsessive-compulsive disorder (OCD) patients. The early and late-onset OCD patients are compared to the control group with a series of neuropsychological measurements. The late-onset OCD patients exhibited impaired performance on the immediate and the delayed recall conditions of the Rey-Osterrieth Complex Figure Test (RCFT) and the letter and category fluency of the Controlled Oral Word Association Test (COWA), compared to the normal controls and the early-onset OCD patients. The controls and early-onset OCD patients did not differ on any of the neuropsychological measurements taken in this study. These results suggest that different neurophysiological mechanisms are in play in early and late-onset OCD patients, and age of onset can serve as a potential marker for the subtyping of OCD. (JINS, 2007, 13, 30–37.)