There is hope for future pharmacological and non-pharmacological strategies to alleviate this socially disastrous condition. The disorder is most prevalent in people of high intelligence at or beyond middle age. We should definitely intervene earlier, before patients refuse any help, and when the syndrome is supposedly milder, to improve our clinical knowledge, follow patients prospectively, experiment hypothesis in laboratory settings, and launch randomized controlled trials for treatments.
From a neurocognitive standpoint, frontal vulnerability certainly disrupts normal decision-making processes, explaining squalor, pathological hoarding, and lack of insight but we need to better understand the connection between the main symptoms and the neural underpinning of the full syndrome. This case report provides a rare opportunity to better understand the distinction of Diogenes syndrome from the closely related condition hoarding disorder. Known for more than 40 years mainly by geriatricians, psychiatrists, nurses or social workers and more recently by forensic specialists, the fine grained mechanisms of the syndrome are still incompletely understood. Diogenes syndrome is highly comorbid with psychiatric and somatic disorders, including depression, obsessive-compulsive disorder, personality disorder, and stress. DS is a clinically complex transnosographic syndrome for which multidimensional approaches need to be considered: medical, psychiatric, neurological, social, scientific, and ethical.
DS can be secondary when associated to psychosis or bipolar disorder, or primary when it occurs as a single entity, usually in the elderly. Diogenes syndrome (DS) is not a specific disease but a real neurobehavioral syndrome, characterized by severe domestic squalor, pathological hoarding, lack of insight into the condition, and no need for help.