Efficacy of Electroconvulsive Therapy for Comorbid Frontotemporal Dementia with Bipolar Disorder

Paul, Sean; Goetz, Jennifer; Bennett, Jeffrey A.; Korah, Tessy

doi:10.1155/2013/124719

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…During the acute phase, there was no report on change in the stimulus location from bilateral to unilateral. Besides, two studies did not disclose the position of the electrodes 32,33 . Probably due to the severity of agitation and other behavior disorders, the choice of stimulus application was predominantly bilateral.…”

Section: Discussionmentioning

confidence: 99%

“…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 . Noteworthy, in the report by McDonald and Thompson 11 , an 85-year-old patient had the baseline diagnosis of dementia changed to 'pseudodementia' because of significant cognitive improvement after ECT treatment.…”

Section: Case Reportsmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…Similar response rates were repeatedly observed in depressed patients with and without dementia or MCI both in retrospective [ 200 ] and prospective studies [ 201 , 202 ]. While only a few bipolar depressed patients were included in some of these samples, effective ECT treatment of bipolar depression with comorbid dementia has been also reported in two patients, one affected by FTD [ 203 ] and the other by multiple system atrophy [ 204 ], respectively showing catatonic and melancholic features. Two patients effectively treated with ECT for agitated delusional depression in the context of AD have also been described [ 205 ].…”

Section: Pharmacological and Physical Treatment Of (Hypo)manic Sympto...mentioning

confidence: 99%

Bipolar Disorder and Manic-Like Symptoms in Alzheimer’s, Vascular and Frontotemporal Dementia: A Systematic Review

Elefante

Brancati

Torrigiani

et al. 2023

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Background: An increased risk of manic episodes has been reported in patients with neurodegenerative disorders, but the clinical features of bipolar disorder (BD) in different subtypes of dementia have not been thoroughly investigated. Objectives: The main aim of this study is systematically review clinical and therapeutic evidence about manic syndromes in patients with Alzheimer’s disease (AD), vascular dementia (VD), and frontotemporal dementia (FTD). Since manic-mixed episodes have been associated with negative outcomes in patients with dementia and often require medical intervention, we also critically summarized selected studies with relevance for the treatment of mania in patients with cognitive decline. Methods: A systematic review of the literature was conducted according to PRISMA guidelines. PubMed, Scopus and Web of Science databases were searched up to February 2022. Sixty-one articles on patients with AD, VaD or FTD and BD or (hypo)mania have been included. Results: Manic symptoms seem to be associated with disease progression in AD, have a greatly variable temporal relationship with cognitive decline in VaD, and frequently coincides with or precedes cognitive impairment in FTD. Overall, mood stabilizers and electroconvulsive therapy may be the most effective treatments, while the benefits of short-term treatment with antipsychotic agents must be balanced with the associated risks. Importantly, low-dose lithium salts may exert a neuroprotective activity in patients with AD. Conclusion: Prevalence, clinical features and treatment response to pharmacotherapy of manic syndromes in patients with dementia may be differentially affected by the nature of the underlying neurodegenerative conditions.

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Bifrontal electroconvulsive therapy leads to improvement of cerebral glucose hypometabolism in frontotemporal dementia with comorbid psychotic depression – a case report

et al. 2023

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Background Differentiating depression and dementia in elderly patients represents a major clinical challenge for psychiatrists. Pharmacological and non-pharmacological treatment options for both conditions are often used cautiously due to fear of adverse effects. If a clinically indicated therapy is not initiated due to fear of adverse effects, the quality of life of affected patients may significantly be reduced. Case presentation Here, we describe the case of a 65-year-old woman who presented to the department of psychiatry of a university hospital with depressed mood, pronounced anxiety, and nihilistic thoughts. While several pharmacological treatments remained without clinical response, further behavioral observation in conjunction with 18F-fluoro‐2‐deoxy‐D‐glucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed the diagnosis of frontotemporal dementia (FTD). To counter the pharmacological treatment resistance of psychotic depression, we decided to perform electroconvulsive therapy (ECT). Remarkably, ten sessions of ECT yielded an almost complete remission of depressive symptoms. In addition, the patient’s delusional ideas disappeared. A follow-up 18F-FDG PET/CT after the ECT series still showed a frontally and parieto-temporally accentuated hypometabolism, albeit with a clear regression compared to the previous image. The follow-up 18F-FDG PET/CT thus corroborated the diagnosis of FTD, while on the other hand it demonstrated the success of ECT. Conclusions In this case, ECT was a beneficial treatment option for depressive symptoms in FTD. Also, 18F-FDG PET/CT should be discussed as a valuable tool in differentiating depression and dementia and as an indicator of treatment response.

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Efficacy of Electroconvulsive Therapy for Comorbid Frontotemporal Dementia with Bipolar Disorder

Cited by 3 publications

References 10 publications

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

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

Bipolar Disorder and Manic-Like Symptoms in Alzheimer’s, Vascular and Frontotemporal Dementia: A Systematic Review

Bifrontal electroconvulsive therapy leads to improvement of cerebral glucose hypometabolism in frontotemporal dementia with comorbid psychotic depression – a case report

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