1. Catatonia and FTD MALAKOUTI RASOUL HOSPITAL, GERIATRIC PSYCHIATRY

2. Subtypes of FTD Focal frontal atrophy Anterior portion of temporal atrophy Semantic dementia Progressive nonfluent aphasia

3. Akinesia Gait disturbances Rigidity Tremor, less frequent

4. Progressive non fluent aphasia Preserved comprehension Gestural apraxia Speech production impaired

5. Semantic dementia At early stage Speech production is fluent, gramatical Free of paraphasia Comprehension is impaired Prosopagnosia Object agnosia

6. FTD & catatonia share with: Paucity of speech Stereotype behavior Excesstive motor activity Echolalia Disinhibition of orbitomedial atrophy

7. Apathy due to Frontal lobe atrophy Semantic imairment due to atrophy of LT anterior temporal

8. SPECT Hypoperfusion of frontal lobe Hypo glucose metabolism of frontal and anterior temporal lobe Bitemporal and bifrontal glucose hypo.. Bithalamus hyper metabolism

9. Presented with depression and ended to FTD

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

11. Low DA in frontal Low GABA-A receptor Frontal anomalies Glutamat antagonist therapy in the treatment of catatonia

13. 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

14. 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.