Very late onset narcolepsy type 1: a case report and review of the literature

Narcolepsy type 1 can first appear as late as the sixth decade of life, as illustrated by the case of a 64-year-old woman whose main symptom was new-onset visual hallucinations. Diagnosis was confirmed by measuring low orexin (hypocretin-1) levels in cerebrospinal fluid. The authors argue that clinicians should consider narcolepsy type 1 as a possible, though rare, diagnosis in older adults presenting with new neuropsychiatric symptoms such as visual hallucinations, even though the disorder typically begins in the second or third decade.

Study at a glance

Abstract

Narcolepsy type 1 is a clinical syndrome defined by recurrent episodes of excessive daytime sleepiness, episodes of cataplexy, hypnagogic hallucinations, and sleep paralysis. Symptoms typically manifest in the second or third decade with another small peak in the fourth decade. In this report we describe the case of a 64-year-old female presenting with new-onset visual hallucinations as the main complaint. Eventually diagnosis of narcolepsy type 1 was confirmed by determination of orexin levels (hypocretin-1) on cerebrospinal fluid. This case illustrates that age of onset of narcolepsy type 1 can be as late as the sixth decade in life and that narcolepsy type 1 should be considered as a possible though rare diagnosis in older adults presenting with new onset neuropsychiatric symptoms like visual hallucinations. Martens J, Van Den Bossche M. Very late onset narcolepsy type 1: a case report and review of the literature. J Clin Sleep Med. 2025;21(5):917–929.