Catatonia and FTD

MALAKOUTIRASOUL HOSPITAL, GERIATRIC

PSYCHIATRY

Subtypes of FTD

• Focal frontal atrophy• Anterior portion of temporal atrophy• Semantic dementia• Progressive nonfluent aphasia

• Akinesia• Gait disturbances• Rigidity• Tremor, less frequent

Progressive non fluent aphasia

• Preserved comprehension• Gestural apraxia• Speech production impaired

Semantic dementia

• At early stage• Speech production is fluent, gramatical• Free of paraphasia• Comprehension is impaired• Prosopagnosia• Object agnosia

FTD & catatonia share with:

• Paucity of speech• Stereotype behavior• Excesstive motor activity• Echolalia• Disinhibition of orbitomedial atrophy

• Apathy due to• Frontal lobe atrophy• Semantic imairment due to atrophy of LT

anterior temporal

SPECT

• Hypoperfusion of frontal lobe• Hypo glucose metabolism of frontal and

anterior temporal lobe• Bitemporal and bifrontal glucose hypo..• Bithalamus hyper metabolism

Presented with depression and ended to FTD

• At progressive stage:• Stereotypic speech• I don’t know to questions• Balance problem, fallen• Mild rigidity• Grasp reflex• myoclonus

• Low DA in frontal• Low GABA-A receptor• Frontal anomalies• Glutamat antagonist therapy in the treatment

of catatonia

Possible relationships of catatonoid signs requiring future confirmation

• include insufficient GABA-A (multiple signs) • D2 (mutism) • excessive NMDA (immobility, rigidity), • D2/D3 (mannerisms, verbal perseveration)• 5HT1a (staring) receptor stimulation

Sequential therapeutic trials for catatonoid frontal signs in clinically-evident frontotemporal dementia

• benefits for lorazepam, amantadine, memantine, pramipexole, aripiprazole, quetiapine, citalopram, and donepezil,

• Citalopram and donepezil were poorly tolerated. • Ramelteon was without effect. • memantine appeared to improve cognition • Parkinsonism (case 2) responded to pramipexole, but

not amantadine or levodopa. • Low-dose lorazepam and quetiapine required close

monitoring.