Electroconvulsive therapy in individuals with dementia/major NCD presenting with behavioral symptoms: a systematic review

Abstract

Objective: This study aims to systematically review the literature on using electroconvulsive therapy (ECT) in patients with dementia/major NCD (Neuro cognitive disorder) presenting with behavioral symptoms. Design: We conducted a PRISMA-guided systematic review of the literature. We searched five major databases, including PubMed, Medline, Embase, Cochrane, and registry (ClinicalTrials.gov), collaborating with “ECT” and “dementia/major NCD” as our search terms. Measurements: Out of 445 published papers and four clinical trials, only 43 papers and three clinical trials met the criteria. There were 22 case reports, 14 case series, 4 retrospective chart reviews, 1 retrospective case–control study, 1 randomized controlled trial, and 2 ongoing trials. We evaluated existing evidence for using ECT in dementia/major NCD patients with depressive symptoms, agitation and aggression, psychotic symptoms, catatonia, Lewy body dementia/major NCD, manic symptoms, and a combination of these symptoms. Settings: The studies were conducted in the in-patient setting. Participants: Seven hundred and ninety total patients over the age of 60 years were added. Results: All reviewed studies reported symptomatic benefits in treating behavioral symptoms in individuals with dementia/major NCD. While transient confusion, short-term memory loss, and cognitive impairment were common side effects, most studies found no serious side effects from ECT use. Conclusion: Current evidence from a systematic review of 46 studies indicates that ECT benefits specific individuals with dementia/major NCD and behavioral symptoms, but sometimes adverse events may limit its use in these vulnerable individuals.

Ketamine Augmentation of Electroconvulsive Therapy: A Scoping Review of Dose-Dependent Effects in Major Depressive Disorder

“…Despite the availability of more than 25 FDA-approved medications for MDD, treatment-resistant depression (TRD) remains prevalent, with approximately 30% of patients failing to achieve remission after multiple trials of first-line antidepressants [4]. Although ECT is an effective treatment for severe depression, its usage is limited due to side effects (transient confusion, short-term memory loss, and cognitive impairment), the need for hospitalization, and stigma [5].…”