ECT Treatment for Two Cases of Dementia-Related Aggressive Behavior

Wu, Qun; Prentice, Glenn; Campbell, John J.

doi:10.1176/jnp.2010.22.2.247.e10

Cited by 11 publications

(4 citation statements)

References 4 publications

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“…Seven case reports have recently shown the safety and efficacy of ECT in the treatment of agitation [34][35][36][37], aggression [36,38], treatment-resistant depression [39] and vocally disruptive behaviour (pathological yelling) [40]. Both a cohort study [41] and a naturalistic prospective study [42] support these observations.…”

Section: Electroconvulsive Therapymentioning

confidence: 86%

Interventional psychiatry in the management of behavioural and psychological symptoms of dementia: a qualitative review

2019

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INTRODUCTION: "Behavioural and psychological symptoms of dementia" (BPSD) refers to a heterogeneous group of clinical manifestations related to dementia, including apathy, depression, anxiety, delusions, hallucinations, sexual or social disinhibition, sleep-wake cycle disturbances, aggression, agitation and other behaviours considered inappropriate. Because of the complexity and heterogeneity of BPSD, as well as the fragility and multimorbidity of the elderly, pharmacological treatment appears to be limited in terms of safety and efficacy, and nonpharmacological therapies are today considered the first choice. There is growing evidence that interventional approaches such as electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS) could be safe and efficient options for several psychiatric illnesses in a population presenting resistance to and/or intolerance of pharmacotherapy.AIMS: The aim of the present work is to provide a qualitative review of the state of the art in interventional psychiatry in the treatment of BPSD. A particular focus will be on depression and agitation, which represent major stressors on caregivers and a primary cause of institutionalisation. CONCLUSIONS: ECT is probably the most promising interventional procedure needing further investigation in order to obtain specific protocols and a consensus on indications. Preliminary data on rTMS, tDCS, and VNS are encouraging although randomised controlled trials to investigate and compare their efficacy in the treatment of BPSD are still lacking. Their feasibility profile could represent an important advantage over ECT. DBS could represent a very effective therapy for behavioural disorders, but knowledge of the precise neuroanatomical targets for BPSD is currently too limited to justify this invasive approach.

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Section: Electroconvulsive Therapymentioning

confidence: 86%

Interventional psychiatry in the management of behavioural and psychological symptoms of dementia: a qualitative review

2019

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“…Furthermore, in Grant an Mohan 23 study, the worsening of cognition was debatable and could be attributed to the severe stage of dementia per se. Nevertheless, in most studies, cognition was not reported, and due to agitation and behavioral disturbances, among others, a standardized cognitive assessment was not available [14][15][16]22,24,26,27,29,32 .…”

Section: Discussionmentioning

confidence: 99%

“…Patients underwent ECT since they did not respond sufficiently to psychopharmacological treatment. In 9 reports the ECT leads were placed bilaterally -bifrontal or bitemporal 11,15,16,[23][24][25][26][27][28][29] -followed by right unilateral ECT in 2 reports 30,31 . Two publications did not disclose the lead placement 32,33 .…”

Section: Case Reportsmentioning

confidence: 99%

Electroconvulsive therapy for treating patients with agitation and related behavioral disorders due to dementia: a systematic review

Stella

Radanovic

Neto

et al. 2023

Dement. neuropsychol.

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Behavioral disturbances are clinically relevant in patients with dementia, and pharmacological regimens to mitigate these symptoms have provided limited results. Proven to be effective in several psychiatric conditions, electroconvulsive therapy is a potentially beneficial strategy for treating severe agitation due to dementia. Objective: This review aimed to examine the publications on the efficacy, safety and tolerability of electroconvulsive therapy in treating patients with agitation due to dementia. Methods: We performed a systematic analysis on the electroconvulsive therapy to treat patients with dementia and coexisting severe agitation. Articles were classified according to the level of evidence based on methodological design. Patients received an acute course of electroconvulsive therapy, often followed by maintenance intervention. Results: We selected 19 studies (156 patients; 64.1% women; 51–98 years old), which met the inclusion criteria: one case-control study by chart analysis (level of evidence 2); one open-label study (level of evidence 3); three historical/retrospective chart analyses (level of evidence 4); and 14 case series/reports (level of evidence 5). No randomized, sham-controlled clinical trials (level of evidence 1) were identified, which represents the main methodological weakness. Some patients had postictal delirium, cardiovascular decompensation and cognitive changes, lasting for a short time. Conclusions: Overall, patients achieved significant improvement in agitation. However, the main finding of the present review was the absence of methodological design based on randomized and sham-controlled clinical trials. Despite methodological limitations and side effects requiring attention, electroconvulsive therapy was considered a safe and effective treatment of patients with severe agitation and related behavioral disorders due to dementia.

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“…A review of the literature indicates that there are 20 published reports on the use of ECT for the management of BPSD [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. These reports included a total of 172 individuals with dementia.…”

Section: Evidence For Using Ect In the Management Of Bpsdmentioning

confidence: 99%

The Place for Electroconvulsive Therapy in the Management of Behavioral and Psychological Symptoms of Dementia

Tampi

Tampi²,

Young

et al. 2019

Neurodegener. Dis. Manag.

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ECT Treatment for Two Cases of Dementia-Related Aggressive Behavior

Cited by 11 publications

References 4 publications

Interventional psychiatry in the management of behavioural and psychological symptoms of dementia: a qualitative review

Interventional psychiatry in the management of behavioural and psychological symptoms of dementia: a qualitative review

Electroconvulsive therapy for treating patients with agitation and related behavioral disorders due to dementia: a systematic review

The Place for Electroconvulsive Therapy in the Management of Behavioral and Psychological Symptoms of Dementia

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