Periodic catatonia in the elderly: A case series highlighting the diagnostic challenge between delirium and catatonia

Differentiating catatonia from delirium in elderly patients presents significant diagnostic challenges due to overlapping clinical features. This case series describes three elderly patients with periodic catatonia characterized by alternating states of stupor and agitation. Specific features, such as negativism and refusal to eat, were pivotal in distinguishing catatonia from delirium. Febrile episodes in these cases appeared to exacerbate symptoms, suggesting a potential role for systemic inflammation and cortico-striato-thalamo-cortical (CSTC) circuit dysfunction in the pathophysiology. Treatment with benzodiazepines and electroconvulsive therapy yielded positive outcomes, emphasizing the importance of early recognition and targeted intervention. Emerging evidence supporting the role of neuroinflammation and CSTC disruptions underscores the need for further research on biomarkers, neuroimaging, and novel therapeutic strategies to improve diagnostic accuracy and clinical outcomes in elderly patients with catatonia.