Abstracts
Résumé
La catatonie est un syndrome neuropsychiatrique grave, mais sous-diagnostiqué chez la personne âgée, souvent confondu avec un délirium ou un trouble neurocognitif majeur, ce qui entraine un retard de prise en charge appropriée.
Une femme de 79 ans est admise pour un déclin cognitif rapide, une perte pondérale significative et un retrait social. Les premières évaluations évoquent un trouble dépressif caractérisé ou un trouble neurocognitif majeur. Les investigations neurologiques sont non concluantes. Après l’introduction d’un traitement psychotrope, l’évaluation psychiatrique met en évidence un mutisme, une prise de posture et un ralentissement psychomoteur marqué, répondant aux critères diagnostiques du DSM-5 pour la catatonie. Un test au lorazépam confirme le diagnostic. Les psychotropes sont interrompus et le lorazépam est titré jusqu’à 2 mg quatre fois par jour, avec amélioration clinique significative.
Une tomographie par émission de positons (TEP) cérébrale ultérieure associée à des observations cliniques suggère une maladie d’Alzheimer sous-jacente. Toutefois, la survenue d’un délirium cooccurrent impose une diminution progressive de la benzodiazépine. L’introduction de la mémantine permet le sevrage du lorazépam et une rémission symptomatique complète. La patiente obtient son congé hospitalier. Lors du suivi ambulatoire, la réapparition partielle de symptômes conduit à envisager des options thérapeutiques alternatives.
Ce cas illustre l’importance de reconnaître la catatonie chez les patients âgés présentant un déclin neurocognitif. Il met en évidence les défis diagnostiques et thérapeutiques liés à la coexistence d’une catatonie, d’un délirium et d’un trouble neurocognitif majeur, et souligne la nécessité d’une reconnaissance précoce et d’une approche multidisciplinaire afin d’optimiser le pronostic.
Mots-clés :
- catatonie,
- delirium,
- trouble neurocognitif,
- concomitant,
- personnes âgées
Abstract
Catatonia is a severe but underrecognized neuropsychiatric syndrome that is frequently misdiagnosed as delirium or dementia in older adults, resulting in delayed and potentially inappropriate treatment.
A 79-year-old woman was admitted for rapid cognitive decline, significant weight loss, and social withdrawal. Initial evaluations suggested major depressive disorder or dementia. Neurological investigations were inconclusive. Following the initiation of psychotropic medication, psychiatric assessment revealed mutism, posturing, and marked psychomotor retardation, fulfilling DSM-5 criteria for catatonia. A lorazepam challenge test confirmed the diagnosis. Psychotropic medications were discontinued, and lorazepam was titrated to 2 mg 4 times daily, resulting in significant clinical improvement.
Subsequent brain positron emission tomography (PET) imaging along with clinical evidence supported the presence of an underlying Alzheimer’s disease. However, the emergence of superimposed delirium required gradual benzodiazepine tapering. Memantine was subsequently introduced, allowing lorazepam withdrawal and full symptomatic remission. The patient was discharged home. During outpatient follow-up, recurrence of partial symptoms prompted consideration of alternative therapeutic strategies.
This case underscores the importance of recognizing catatonia in older adults presenting with cognitive impairment. It highlights the diagnostic and therapeutic challenges posed by the coexistence of catatonia, delirium, and neurodegenerative disease, and emphasizes the need for early identification and a multidisciplinary approach to optimize outcomes.
Keywords:
- catatonia,
- delirium,
- dementia,
- cooccurrence,
- elderly
Appendices
Bibliographie
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