Diogenes syndrome presenting with severe self-neglect and hoarding behaviour in an elderly woman: a case report

Abstract

Diogenes syndrome (DS) is an uncommon behavioural condition characterized by severe self-neglect, domestic squalor, hoarding behaviour, social withdrawal, and poor insight. It is frequently associated with psychiatric or neurocognitive disorders but may also occur without a clearly identifiable underlying condition, making diagnosis challenging. We report a 76-year-old woman with a two-year history of collecting discarded materials, progressive deterioration in personal hygiene, and marked neglect of her living environment, along with recent forgetfulness. Despite severe behavioural disturbance, she remained oriented with preserved bedside memory. Clinical evaluation excluded psychotic, mood, obsessive-compulsive, and major neurocognitive disorders. She was managed with psychoeducation, behavioural strategies, caregiver involvement, and low-dose antipsychotic medication, resulting in gradual improvement over five months. This case highlights that severe self-neglect may occur despite preserved cognition, suggesting underlying executive dysfunction rather than global cognitive decline.