Electroconvulsive Therapy for Agitation and Aggression in Dementia: A Systematic Review

Threatening to burn the house down

“…23 Although ECT is not indicated for treating agitation and aggression in patients with dementia, its effectiveness for these symptoms has been discussed extensively in the literature. 22,[24][25][26] Electroconvulsive therapy treatment can be divided into 2 phases: an acute phase during which ECT is administered 2 to 3 times a week for 4 to 5 weeks, and a maintenance phase of weekly treatments for 4 weeks and then biweekly treatments for 8 weeks. 26 Although extensive research supports the safe use of ECT in older adults, concerns for worsening cognitive impairment can deter patients and families from agreeing to this treatment.…”

“…Severe adverse effects such as seizures, severe confusion, and delirium are uncommon. 25 The number of ECT treatments required for a good effect ranges from 2 to 18, and the most common position for electrodes placement is bilateral. Outcomes can be measured by using rating scales such as the Cohen-Mansfield Agitation Inventory, Neuropsychiatric Inventory, Social Dysfunction and Aggression Scale, Clinical Global Impression scale, and Pittsford Agitation Scale.…”

“…Outcomes can be measured by using rating scales such as the Cohen-Mansfield Agitation Inventory, Neuropsychiatric Inventory, Social Dysfunction and Aggression Scale, Clinical Global Impression scale, and Pittsford Agitation Scale. 25 Obtaining consent from patients with dementia is generally not possible because these patients generally lack the capacity to make medical decisions. Clinicians should refer to their state laws regarding medical-decision making in such cases.…”

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

“…Additionally, in those individuals who had a relapse in symptoms, they found benefit from maintenance ECT. In the second systematic review by van den Berg et al, the authors found 17 reports that evaluated the use of ECT among individuals with BPSD [35]. The investigators reported that they found one prospective cohort study and one case-control study, whereas the others were retrospective chart reviews, case series or case reports.…”

Use of ECT in Major Vascular Neurocognitive Disorder with Treatment-Resistant Behavioral Disturbance following an Acute Stroke in a Young Patient

“…Treatment of behavioral disturbances (agitation, aggression, aberrant vocalization, and interference/refusal of care) is a common reason for admission to the geriatric psychiatric unit and frequently involves careful consideration of the risks and benefits associated with pharmacologic treatment of these symptoms, particularly in the era of FDA black box warnings suggesting increased risk of mortality in elderly individuals with dementia treated with antipsychotics. While there is no FDA-approved treatment for behavioral disturbance in dementia, various classes of medications are commonly used depending on target symptoms, including antidepressants, atypical antipsychotics, anticonvulsants, and benzodiazepines [9]. Treatment strategies for behavioral disturbance resistant to traditional nonpharmacologic and pharmacologic management are limited.…”