LATE PARAPHRENIA, ADVANCED SCHIZOPHRENIC DETERIORATION AND DEMENTIA

This is a report of a clinical case presentation from the Neuropsychia try Conference held at Fulbourn Hospital, Cambridge on March 13, 1992. The conference, chaired by Dr Nigel Hymas, was asked to comment on th e diagnosis of a case first referred during September 1990. A 60-year- old man with no previous history of psychiatric illness presented with persecutory ideation, delusions and hallucinations in the absence of cognitive impairment. At the time, the initial tentative psychiatric d iagnosis was one of late paraphrenia, but it later became clear that t he patient was dementing. Were the paraphrenia and dementia related? I f so, how? What was the nature of the dementing illness? Could life-lo ng personality abnormalities have been the earliest expression of cere bral abnormalities predisposing him to his current illness? Incompatib le evidence from clinical features, functional brain scanning and comp rehensive neuropsychological testing demonstrates the inadequacy of cu rrent diagnostic criteria.