Narcolepsy in the Elderly: A Forgotten Diagnosis

Kelly, Jennifer F.; Lowe, Dermot; Taggart, Helen M.

doi:10.1093/ageing/16.6.405

Cited by 8 publications

(5 citation statements)

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“…The few previously reported cases of NC with an onset at an older age were initially misdiagnosed and, thus, the diagnosis was delayed. In 1987, Kelly et al [5] reported 2 cases: the first was a male with symptom onset at 72 years and the second a female at 84 years. In both cases, the diagnosis of NC was considerably delayed (15 years in the first case, misdiagnosed as secondary epilepsy).…”

Section: Discussionmentioning

confidence: 99%

“…Possible later onset is indicated as rare throughout studies; in Roth [3], only 4 out of 288 cases had onset after 50 years. To our knowledge, only 3 cases of NC onset at around age 70 years have been described: all of them are not clinically clear [4, 5]. We would like to present an undoubtedly diagnosed late-onset NT1 in a 69-year-old male subject.…”

Section: Introductionmentioning

confidence: 98%

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Rare Case of Late-Onset Narcolepsy Type 1

Kovalská

Dostálová

Machová³

et al. 2020

Case Rep Neurol

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A 69-year-old male developed symptoms typical of the diagnosis of narcolepsy type 1 without any previous triggering events. First, daytime sleepiness occurred, soon followed by cataplexy. Nocturnal polysomnography revealed rapid eye movement (REM) sleep behavior disorder, a apnea-hypopnea index of 25.8 events/h, and no sleep-onset REM. Multiple Sleep Latency Test showed a mean sleep latency of 2.1 min and REM sleep in 3 tests. HLA DQB1*06:02 was positive and hypocretin-1 in cerebrospinal fluid unmeasurable. A treatment with 50 mg clomipramine controlled the cataplexy; excessive daytime sleepiness was sufficiently managed by repeated naps. The administration of 0.25 mg of clonazepam subjectively improved REM sleep behavior disorder. Bilevel Positive Airway Pressure improved the apnea-hypopnea index without important influence on sleepiness. Our unique case demonstrates that even elderly subjects can develop narcolepsy type 1.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Rare Case of Late-Onset Narcolepsy Type 1

Kovalská

Dostálová

Machová³

et al. 2020

Case Rep Neurol

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“…16 In others, mild disease severity, misdiagnosis or long delays in cataplexy expression may prevent proper diagnosis and treatment. 17,18 Chakravete and Rye 18 estimated that it first comes to medical attention after the age of 40 years in nearly half of affected patients. Rye and associates 19 stressed that, during differential diagnosis, narcolepsy should always be considered by physicians faced with an older patient experiencing sleepiness or with transient loss of muscle tone.…”

Section: Narcolepsymentioning

confidence: 99%

Sleep and aging: 1. Sleep disorders commonly found in older people

Wolkove

Elkholy²,

Baltzan³

et al. 2007

Canadian Medical Association Journal

333

174

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Sleep is a vital physiologic process with important restorative functions. Notable qualitative and quantitative changes in sleep occur with age. Moreover, many sleep-related disorders occur with increasing frequency among elderly people. These conditions are often not appreciated by physicians, the associated symptoms ascribed instead to coexistant medical illness. In part 1 of this review, we attempt to summarize several of the most important sleeprelated disorders commonly observed in older patients. In the forthcoming part 2, we will highlight the principles of treatment of these conditions. Age-related sleep changesNormal sleep progresses through several stages in a predictable fashion (Table 1). This cycle repeats several times during the sleep period. With age, important changes in sleep structure occur (Box 1); 1 perhaps most characteristic is a phase advance of the normal circadian cycle. The result is a propensity toward an earlier sleep onset, accompanied by an earlier morning wake signal. Thus, elderly people often go to bed early and report being early risers. With aging, the total amount of time asleep shortens: infants and young children sleep an average of 16-20 hours per day; adults, 7-8; and people over 60 years of age, 6 1 /2 hours daily.2 Delta sleep (stages 3 and 4), the deepest and most refreshing form of sleep, diminishes with age. 2 Sleep pathologies in older patients InsomniaInsomnia, defined as difficulty falling or staying asleep, is frequent in older people.1,2 In some patients, insomnia can be caused by an underlying medical condition or a medication side effect (secondary insomnia). In the absence of a causative factor, it is referred to as primary insomnia. Monane 3 has estimated that insomnia affects nearly half of all those over the age of 65 years. Elderly women tend to report sleep disturbances more frequently than elderly men.4 The sleep changes noted among older women may be partly related to changes in the postmenopausal profile of sex hormones. Estrogen deficiency in particular has been postulated to contribute to the sleep difficulties that women often begin to experience in their perimenopausal period, and then increasingly with age. 5Frequent awakenings are particularly common among elderly people and may be related to their more frequent incidences of concurrent medical conditions. Among the most common causes of secondary insomnia are a variety of musculoskeletal disorders, nocturia related to benign prostatic hypertrophy in men and bladder instability with decreased urethral resistance in women, congestive heart disease, and chronic obstructive lung disease.Depression and anxiety disorders, common among people over 65 years of age, frequently contribute to insomnia. 6Risk factors for depression in older people include loss of a spouse, retirement, social isolation, comorbid disease and onset of dementia.Sleep disturbance or disruption is common among patients experiencing dementia, particularly those with Alzheimer's disease.7 Such patients often have difficulty not on...

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“…Even after finding mild obstructive sleep apnea and treating it with CPAP in our patient, her narcolepsy symptoms did not improve. The prevalence of narcolepsy in the elderly population is exceedingly rare but has been reported in a few cases [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…An article published in 1987 describes two cases of delayed diagnosis of narcolepsy in elderly patients causing significant psychosocial problems [ 13 ]. Another case report describes a 60-year-old patient who presented with classic narcolepsy with frequent cataplexy.…”

Section: Discussionmentioning

confidence: 99%

A Rare Presentation of Narcolepsy With Cataplexy After Vaccines in a Genetically Susceptible Elderly Woman: A Case Report

Verma¹,

Prasad²,

Rath³

et al. 2023

Cureus

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Observing cataplexy episodes during an office visit is extremely rare as they are usually triggered by laughter or emotional stress. Narcolepsy usually occurs in the younger population. We report a case of a 65-year-old Caucasian female with a past medical history of obesity who developed excessive daytime sleepiness, fatigue, and sleep attacks five weeks after getting influenza and pneumococcal vaccines. The presentation of cataplexy was atypical. Several episodes of cataplexy were observed during the office visit without any emotional trigger. Further workup, including polysomnography (PSG), was positive for obstructive sleep apnea, controlled with continuous positive airway pressure (CPAP) use. Later, she had PSG with CPAP use, which optimally controlled obstructive sleep apnea, followed by multiple sleep latency tests (MSLT) with CPAP use. It was positive for narcolepsy with a mean sleep latency of 1.6 minutes with sleep onset rapid eye movement (REM) in five out of five naps. Her cerebrospinal fluid (CSF) hypocretin level was extremely low at 50 pg/ml, usually seen in narcolepsy with cataplexy. She was also positive for human leukocyte antigen (HLA) DBQ1*06:02. The diagnosis of narcolepsy with cataplexy was made, which improved with medications for narcolepsy.

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Narcolepsy in the Elderly: A Forgotten Diagnosis

Cited by 8 publications

References 0 publications

Rare Case of Late-Onset Narcolepsy Type 1

Rare Case of Late-Onset Narcolepsy Type 1

Sleep and aging: 1. Sleep disorders commonly found in older people

A Rare Presentation of Narcolepsy With Cataplexy After Vaccines in a Genetically Susceptible Elderly Woman: A Case Report

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