Electroconvulsive Therapy for Neuropsychiatric Symptoms due to Major Neurocognitive Disorder

Abstract

ObjectivesNeuropsychiatric symptoms (NPSs) in those with major neurocognitive disorder (MNCD) include the responsive behaviors of agitation and aggression. Electroconvulsive therapy (ECT) has shown some effectiveness based on retrospective studies and one open label prospective study. We hypothesized that ECT will reduce NPSs between baseline and after treatment in those with medication-refractory behaviors.Method/DesignThis Canadian prospective multicenter study included MNCD patients admitted to geriatric psychiatry units for the management of refractory NPSs. All treatment-refractory participants suffered from advanced MNCD. We conducted the Neuropsychiatric Inventory—Clinician version and the Pittsburgh Agitation Scale at baseline, and during and after the ECT course. A bitemporal or bifrontal ECT series based on dose titration to 1.5 to 2.5 times seizure threshold was administered.ResultsData were collected for 33 patients with a mean age of 73 and categorized with severe MNCD using the Functional Assessment Staging of Alzheimer's Disease scale (stages 6 and 7). The data showed a drop in mean Neuropsychiatric Inventory—Clinician version from 58.36 to 24.58 (P < 0.0001). Mean Neuropsychiatric Inventory agitation subscale dropped from 7.12 to 3.09 (P = 0.007). Mean Neuropsychiatric Inventory aggression subscale dropped from 6.94 to 0.97 (P < 0.0001). There was a concomitant significant decline in Pittsburgh Agitation Scale scores. No participants dropped out because of intolerance of ECT. One participant died from pneumonia, which did not appear related to ECT.ConclusionsIn this naturalistic study, ECT was found to be a safe and effective treatment for certain NPSs in people with MNCD. This can translate into improving quality of life.

Editor's Roundup for Issue 2 of 2022

“…Therefore, it is encouraging that, in this issue of the Journal of ECT , Copersino et al 1 report that the antidepressant effect of ECT benefits patients regardless of the presence or absence of baseline cognitive impairments. Chan et al 2 then go further to report that ECT improves neuropsychiatric symptoms in patients with neurocognitive disorders, similar to an earlier report in this Journal 3 . To the extent that cognitive adverse effects are a concern in a particular patient, Miller et al 4 found that high power in the electroencephalogram theta band predicts greater acute cognitive adverse effects from high-dose right unilateral ECT, thus creating an opportunity to monitor the ictal electroencephalogram and accordingly adjust the stimulus dose early in the treatment course.…”