Efficacy and safety of maintenance electroconvulsive therapy for sustaining resolution of severe aggression in a major neurocognitive disorder

Abstract

We report a novel electroconvulsive therapy (ECT) regimen for sustaining the resolution of behavioural and psychological symptoms of dementia (BPSD) using alternating acute and maintenance ECT (M-ECT) trials. A 64-year-old man presenting with major neurocognitive disorder was admitted for acute behavioural disturbances and physical aggression. With few treatment options, the impact on patients’ quality of life often supersedes cognitive symptoms and is a predictor of long-term institutionalisation. Recent studies indicate that ECT may be an effective and safe way to address BPSD. Clinicians have little information about when and how to stop a successful course of acute ECT or the long-term advantages of M-ECT with subsequent intermittent acute ECT. This case emphasises the benefit of M-ECT and describes potential challenges associated with abrupt discontinuation. This case is the first to detail tapering ECT for treatment of aggression in dementia by interchanging acute and M-ECT courses in response to symptom burden.

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

“…Additionally, data regarding appropriate use of maintenance ECT for agitation in dementia are extremely limited. One case report suggests that alternating periods of acute and maintenance frequencies driven by symptom burden may be effective in managing agitation and that slow tapering over weeks to months may be necessary [15].…”

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

“…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.…”

“…None reported [28] AD: Alzheimer's disease; BPSD: Behavioral and psychological symptoms of dementia; ECT: Electroconvulsive therapy; FTD: Frontotemporal dementia; LBD: Lewy body dementia; VD: Vascular dementia.…”

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

“…Behavioural and psychological symptoms of dementia (BPSD) are 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 [1,2]. BPSD are experienced by 50% (point prevalence) to 90% (long-term prevalence) of patients diagnosed with dementia [3,4]. They have a negative impact on cognitive decline [5] and increase secondary complications [6].…”

“…Currently, there is growing evidence that interventional approaches such as electroconvulsive therapy (ECT) [4], repetitive transcranial magnetic stimulation (rTMS) [8,9], transcranial direct current stimulation (tDCS) [10], deep brain stimulation (DBS) [11,12], and vagus nerve stimulation (VNS) [13,14] could be reasonably safe and efficient options for the treatment of several psychiatric illnesses in a population presenting resistance to and/or intolerance of pharmacotherapy.…”