FTD with catatonia-like signs that temporarily resolved with zolpidem

A 69-year-old woman with no family history of mental or neurologic diseases or hypoxic episodes began to show gradual progressive apathy and difficulties in household work at about 50 years of age, followed by emotional blunting. At 68 years of age, she developed catatonia-like signs with little or no spontaneous movement, mutism, and refusal to eat or drink. Frontotemporal dementia (FTD) was suspected because of the bilateral frontal and temporal atrophy shown by an MRI study. At that time, her family found that her symptoms were temporarily resolved with zolpidem without sleepiness. Medical examinations, including a complete blood cell count, and liver, renal, and thyroid function tests, showed no abnormalities. EEG showed dominant α rhythm with occasional slow waves, without any evidence of disturbance of consciousness. Psychotropic agents including zopiclone, lorazepam, brotizolam, alprazolam, diazepam, quazepam, quetiapine, fluvoxamine, lamotrigine, mirtazapine, and amantadine did not resolve her catatonia-like signs. No psychological tests could be performed because of her catatonic state. About 30 minutes after the oral administration of zolpidem (5 mg), her catatonia-like signs gradually ameliorated, and the effect lasted for a few hours. Psychological tests following zolpidem administration demonstrated that her Mini-Mental State Examination score was 21/30, showing disturbances in orientation, attention, and calculation, while the Frontal Assessment Battery score was 11/18 with signs of perseveration that indicated the hypofunction of the frontal lobe. The Bush-Francis Catatonia Rating Scale score changed from 26 to 3 (table). Brain perfusion scans were performed before and after the administration of zolpidem (figure). In both scans, a severe perfusion decrease was observed in bilateral high-frontal lobes, and a mild decrease was observed in bilateral temporal lobes, which was compatible with FTD. After the oral administration of zolpidem, the perfusion was decreased in the brainstem and improved in the thalamus and some cortical areas, including the left parieto-temporal lobe and left cerebellar cortex. The anticatatonic effect of zolpidem has been observed for these 2 years without any side effect.