Idiopathic Basal Ganglia Calcification and Pathological Hoarding

To the Editor: Idiopathic basal ganglia calcification (IBGC) combines basal ganglia calcification on CT scan with progressive neuropsychiatric symptoms.¹ Typically, age at onset of clinical symptoms is 30-60 years. The psychiatric symptoms of IBGC include delusions, hallucinations, mood disorder and changes in personality and behavior. These symptoms cannot be explained by any particular disorder of calcium phosphorus metabolism or other diseases. The etiology of IBGC is unknown, although an autosomal dominant inheritance involving chromosome 14q has been suggested.

Case report

We report the case of a 70-year-old Caucasian woman who was referred to our Psychiatry Department by social workers, in February 2010, for pathological hoarding and ideas of persecution. This patient was reluctant to seek help as hoarding was not seen as problematic. Since the age of 50, she had passively accumulated an eclectic and purposeless hoard of possessions that filled and cluttered all areas of her home. She thus was not able to cook in her kitchen or to use her bathroom. She though displayed little interest in the accumulated items. Subsequently, she had also developed a recurrent depressive disorder and the notion that she was being persecuted by her neighbors. She also reported a history of recurrent depressive disorder in her mother and sister. The patient had no symptoms of obsessive-compulsive disorder (OCD) and hoarding was not secondary to her ideas of persecution. Physical examination reported type 2 diabetes and hypertension (both well managed). Neuropsychiatric examination found slight tremor, postural instability (with gait disturbance), dysarthria and a major depressive episode. A CT scan revealed dense bilateral pallidum calcifications. Laboratory tests, including serum calcium, phosphorus and parathyroid hormone determinations, gave results within normal limits. MMSE score was 29. The patient became normothymic on SSRI and risperidone. However, her ideas of persecution and abnormal hoarding behavior (we discovered that she accumulated food during hospitalization) persisted.

Discussion

To our knowledge, this is the first report of concurrent IBGC and hoarding. We cannot demonstrate a causal relationship between the pallidum calcifications and the hoarding presented by our patient, but the occurrence of these two phenomena in the same patient suggests a possible relationship. Furthermore, it has recently been suggested that hoarders who passively rather than actively collect items may present an organic etiology of their disorder.² These ‘organic’ patients also appear to have little interest in the accumulated items. Finally, Mataix-Cols et al. reported that only the ‘organic’ hoarders appeared to accumulate food.² These lines of evidence strongly suggest a causal relationship between IBGC and hoarding in our patient.