Successful Electroconvulsive Therapy for Major Depression Misdiagnosed as Alzheimer Dementia

Pier, Katherine; Briggs, Mimi C.; Pasculli, Rosa M.; Kellner, Charles H.

doi:10.1097/jgp.0b013e318254619a

Cited by 8 publications

(5 citation statements)

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“…However, our findings are also consistent with literature describing marked improvement of cognitive function in some of these patients (Pier et al, 2012;Wagner et al, 2011), as the cognitive course within the group differed markedly. CIND patients who reverted to normal might have been among those whose cognitive function was temporarily impaired by major depression (McClintock, Husain, Greer, & Cullum, 2010); thus, their baseline performance on the standardized neuropsychological tests did not reflect their cognitive abilities in remission.…”

Section: Discussionsupporting

confidence: 94%

“…Cognitive impairment in the elderly often persists after efficacious treatment of the depression (Bhalla et al, 2009;Butters et al, 2008;Nebes et al, 2003). However, in some individuals, indications of severe cognitive impairment at the baseline are not present after a course of ECT, if remission was achieved (Pier, Briggs, Pasculli, & Kellner, 2012;Stoudemire, Hill, Morris, & Dalton, 1995;Stoudemire et al, 1991;Wagner, McClintock, Rosenquist, McCall, & Kahn, 2011).…”

Section: Introductionmentioning

confidence: 94%

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The Role of Baseline Cognitive Function in the Neurocognitive Effects of Electroconvulsive Therapy in Depressed Elderly Patients

Dybedal

Tanum

Bjølseth

2015

The Clinical Neuropsychologist

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 94%

The Role of Baseline Cognitive Function in the Neurocognitive Effects of Electroconvulsive Therapy in Depressed Elderly Patients

Dybedal

Tanum

Bjølseth

2015

The Clinical Neuropsychologist

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“…At baseline, indications of mild cognitive impairment were found in 27 (41.5%) patients, whereas 15 (23.1%) were no longer categorized as impaired after the ECT course. Similarly, a misdiagnosis of dementia has been reported in elderly patients with MD before they were successfully treated with ECT (Pier et al, 2012;Wagner et al, 2011). However, several studies have demonstrated that despite the improvement observed in some patients after treatment (Dybedal et al, 2015), cognitive functioning remained impaired at the group level in elderly depressed patients who presented with cognitive impairment at baseline (Butters et al, 2000;Sarapas et al, 2012).…”

Section: Discussionmentioning

confidence: 95%

Baseline cognitive function does not predict the treatment outcome of electroconvulsive therapy (ECT) in late-life depression

Bjølseth

Engedal

Benth

et al. 2015

Journal of Affective Disorders

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“…For the vast majority of ECT patients, the cognitive adverse effects are a temporary nuisance and not a reason to avoid a potentially life-saving therapy (116). It should also be remembered that baseline cognitive impairment secondary to the depressed state (sometimes referred to as 'pseudodementia') resolves with successful ECT (117,118).…”

Section: Medical Risks and Adverse Effectsmentioning

confidence: 99%

When to consider electroconvulsive therapy (ECT)

Kellner

Obbels

Sienaert

2019

Acta Psychiatr Scand

142

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When to consider electroconvulsive therapy (ECT) Kellner CH, Obbels J, Sienaert P. When to consider electroconvulsive therapy (ECT).Objective: To familiarize the reader with the role of electroconvulsive therapy (ECT) in current psychiatric medicine. Method: We review clinical indications for ECT, patient selection, contemporary ECT practice, maintenance treatment and ECT in major treatment guidelines. Results: ECT is underutilized largely due to persisting stigma and lack of knowledge about modern ECT technique. Conclusion: ECT remains a vital treatment for patients with severe mood disorders, psychotic illness and catatonia. Clinical recommendations for ECT• ECT should be prescribed earlier in the course of a severe depressive episode, not necessarily withheld until after numerous medication trials • ECT may be considered a first-line (primary) treatment for certain urgently ill patients, including those who are very suicidal, psychotic, or physically debilitated from depression Diagnostic indications for ECT • In many Western countries, severe and treatment-resistant depression is the main indication for ECT • Schizophrenia is the number one indication for ECT worldwide, but is little used for this indication in Western countries • ECT is an effective treatment for treatment-resistant mania • Delirious mania is an urgent indication for ECT • ECT is effective for treatment-resistant schizophrenia, including clozapine-resistant illness • Catatonia is very responsive to ECT • Both the motor and behavioural symptoms of Parkinson's disease respond to ECT Predictors of ECT response • Older age, psychotic symptoms, and shorter episode duration are predictors of better ECT response • Melancholic features and greater baseline depressive symptom severity are likely associated with better ECT response 304 ECT technique • Bilateral, bifrontal, and right unilateral electrode placement are all effective ECT techniques • Less urgently ill patients are often treated initially with right unilateral electrode placement • Brief and ultrabrief pulse width stimuli, now commonly used, are associated with a more benign cognitive effect profile • There is no a priori fixed number of ECT in an acute course: patients should continue treatment with ECT until they remit or a plateau has been reached, or tolerability issues require interruption of the course • Tapering of acute courses of ECT should be considered for most patients (e.g., approximately weekly treatments for several weeks past remission) • Continuation/Maintenance (C/M) ECT should be considered for patients with a history of severe, recurrent episodes who have failed to remain well on medications Additional comments • ECT is underutilized because of stigma, lack of knowledge about it, and bureaucratic restrictions • ECT is among the safest procedures performed under general anesthesia • Cognitive adverse effects are markedly decreased with modern ECT techniques, largely transient, and should not deter seriously ill patients from considering ECT.

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Successful Electroconvulsive Therapy for Major Depression Misdiagnosed as Alzheimer Dementia

Cited by 8 publications

References 5 publications

The Role of Baseline Cognitive Function in the Neurocognitive Effects of Electroconvulsive Therapy in Depressed Elderly Patients

The Role of Baseline Cognitive Function in the Neurocognitive Effects of Electroconvulsive Therapy in Depressed Elderly Patients

Baseline cognitive function does not predict the treatment outcome of electroconvulsive therapy (ECT) in late-life depression

When to consider electroconvulsive therapy (ECT)

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