a1 Department of Psychiatry, University Medical Centre St. Radboud, Nijmegen, The Netherlands
a2 Pro Persona, Nijmegen Mental Health Centre, The Netherlands
a3 Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Psychiatry, Nijmegen, The Netherlands
a4 Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
a5 University Center for Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
Background: As autism spectrum disorders (ASD) have largely been neglected in old-age psychiatry, the objective of the present paper is to describe the diagnostic process in elderly patients.
Methods: A systematic review of the literature on ASD in older age was undertaken and illustrated by a case series of three elderly patients first diagnosed with ASD in later life by a tertiary mental health clinic.
Results: The search of the literature only yielded three papers on late-life ASD, while the review of the available diagnostic procedures among adults suggests some relevance for screening instruments (Autism Questionnaire), diagnostic instruments (Module 4, Autism Diagnostic Observation Schedule), and neuropsychological examination to profile impairments. Nonetheless, the case reports clearly showed that taking a thorough history with the patient, corroborated and supplemented by a close relative or caregiver who has known the patient for at least ten years, still remains the most important diagnostic tool.
Conclusion: The three case studies show that in clinical practice ASD can easily be missed in elderly individuals presenting with comorbid psychiatric disorders, potentially causing iatrogenic damage. Although further research on phenotyping and diagnosing ASD in older people is warranted, the most important step at this point is to create a greater awareness of the possibility of ASD in old age among health-care professionals working with people in this age group.
(Received June 26 2010)
(Revised July 22 2010)
(Revised October 08 2010)
(Accepted October 11 2010)
(Online publication November 29 2010)
c1 Correspondence should be addressed to: Maarten E. H. van Niekerk, MD, University Medical Center Nijmegen, Department of Psychiatry (333), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. Phone: +31 (0)24–3617197; Fax: +31 (0)24–3617855. Email: [email protected].