Objective: This study evaluates neuropsychiatric comorbidity in spinocerebellar ataxia (SCA) and highlights key aspects of management in the geriatric population. It discusses efficacy of neuropsychotropic interventions and provides insight into the interplay between motor and mood decline coalescing into neuropsychiatric sequelae.

Background: SCA is a neurodegenerative disorder that precipitates progressive disturbances in motor coordination. With no definitive cure, management typically addresses complications such as tremors or seizures. However, focus on motor manifestations often detracts from psychiatric morbidity, particularly in the elderly where such concerns may be under-appreciated. As such, clinicians must be aware of neuropsychiatric symptoms and available therapies to improve quality of life.

Method: Through case analysis of a 67-year-old male diagnosed with SCA and later unspecified anxiety and major depressive disorder (MDD), this investigation synthesizes clinical assessments, neuroimaging, and psychiatric interventions into a longitudinal analysis of motor and mood outcomes over one year. It then informs how such findings may guide multi-disciplinary treatment for future patients.

Results: The patient’s SCA was defined by progressive ataxia with loss of independence accompanied by unrecognized apathy. Only when the patient mentioned depressed mood, decades after diagnosis, was he referred to establish psychiatric care, where he was found to have significant anxiety and MDD complicated by prior hospitalizations for suicidal ideation due to loss of motor function. Following integration of psychiatric care involving cognitive-behavioral therapy and psychotropic medications, his mood and psychosocial adaptability improved significantly despite the relentless progression of SCA in the setting of advancing age.

Conclusion: This study highlights the need for early recognition of psychiatric comorbidity in patients with SCA, as worsening mood may develop at any time after diagnosis and carry mortality risk in those with active suicidal ideation and attempt. A multi-disciplinary approach in managing SCA with mood disturbance is even more consequential in the geriatric population, where additional barriers present, such as poor psychosocial support, concern for polypharmacy, and decreased independence and ability to advocate for oneself.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/improving-neuropsychiatric-comorbidity-in-geriatric-spinocerebellar-ataxia/