Vascular psychosis in the elderly: response to clozapine

Cerebrovascular disease is a cause of late-onset psychosis in the elderly more frequent, accompanied or not, multi-infarct dementia. In many cases the patient has adequate preservation of cognitive functions or in any case, no criteria for dementia. In those that do, is in vascular dementia where psychotic symptoms are more frequent, occurring in over half cases, compared to one third of patients with Alzheimer disease. A case of a 92 year-old woman with no somatic background -except for a bilateral progressive hearing loss-, who debuted at this age with psychotic delusions structured injury and auditory hallucinations. The CT scan showed signs of cortico-subcortical atrophy. Neuropsychological examinations showed some cognitive impairment but no clinical criteria for dementia. Was refractory to first-line atypical antipsychotics, remitting symptoms after administration of low doses of clozapine. We discuss the clinical features of this psychosis, as well as its therapeutic approach.