Electroconvulsive therapy (ECT) for treating agitation in dementia (major neurocognitive disorder) – a promising option

Abstract

Available studies are often limited by concomitant psychotropic medications, inconsistent use of objective rating scales, short follow-up, lack of a control group, small sample sizes, and publication bias. A future randomized controlled trial will pose ethical and methodological challenges. A randomized controlled trial must carefully consider the definition of usual care as a comparison group. Well-documented prospective studies and/or additional case series with explicit selection criteria, a wide range of outcome measures, and less selection bias of the study sample that may favor treatment response, is warranted. ECT may be a promising option for the treatment of aggression and agitation in patients with severe dementia who are refractory to other treatment options, but the limitations of available studies suggest that a cautious approach to future randomized controlled trials is warranted.

Royal Australian and New Zealand College of Psychiatrists professional practice guidelines for the administration of electroconvulsive therapy

“…It should be considered as a therapeutic option alongside other treatments after detailed psychiatric assessment. Indications for ECT include the treatment of the following: ECT may also have a role in the treatment of severe and repetitive self-injurious behaviours in autism (Ghaziuddin and Walter, 2013), and for the treatment of agitation and aggression in patients with dementia (Glass et al, 2017;Isserles et al, 2017;Manjola, 2015), though should only occur in these circumstances and for other emerging indications in consultation with a psychiatrist with expertise in the use of ECT for such indications. There is also potential application of ECT in the treatment of severe Parkinsonism not responsive to medication with the on-off phenomenon and the occasional use of ECT for intractable temporal lobe epilepsy (Surya et al, 2015).…”

δ scores predict multiple neuropsychiatric symptoms

“…This model suggests that ECT, rather than rTMS, should be more effective against p/δ-related psychopathology. 45 In contrast to regionally specific monoamines, various δ homologs have been shown to be associated with a wide range of widely circulating serum proteins, including pro-and anti-inflammatory cytokines.…”

Pharmacotherapy of Behavioral and Psychological Symptoms of Dementia: State of the Art and Future Progress

“…An alternative method of treating agitation in dementia is by electroconvulsive therapy (ECT). A recent review of papers investigating the use of ECT for treating agitation in dementia ( Glass et al., 2017 ) identified 11 papers, with a total number of 216 patients. The studies indicate promising results in decreasing agitation in patients with dementia; however, the studies have many methodological limitations regarding the type of study, use of psychotropic medications, choice of scales, lack of control group and numer of patients, among others.…”