Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia

Abstract

Objective Agitation and aggression are among the most frequent and disruptive behavioral complications of dementia that contribute to increased cost of care, hospitalization, caregiver burden, and risk of premature institutionalization. This current study examined the safety and efficacy of electroconvulsive therapy (ECT) as a treatment for behavioral disturbances in dementia. We hypothesized that ECT would result in reduced agitated and aggressive behaviors between baseline and discharge. Methods Twenty-three participants admitted to McLean Hospital (Belmont, MA) and Pine Rest Christian Mental Health Services (Grand Rapids, MI), with a diagnosis of dementia who were referred for ECT to treat agitation and/or aggression, were enrolled in the study. We administered the Cohen-Mansfield Agitation Inventory (CMAI)-short form, Neuropsychiatric Inventory (NPI)-Nursing Home Version, Cornell Scale for Depression in Dementia (CSDD), and the Clinical Global Impression Scale (CGI) at baseline, during, and after the ECT course. Results Regression analyses revealed a significant decrease from baseline to discharge on the CMAI (F(4, 8) =13.3; p=0.006) and NPI (F(4, 31)= 14.6; p<0.001). There was no statistically significant change in scores on the CSDD. The CGI scores on average changed from a rating of “markedly agitated/aggressive” at baseline to “borderline agitated/aggressive” at discharge. Treatment with ECT was well tolerated by most participants; discontinuation of ECT occurred for two participants due to recurrence of agitation and for three participants due to adverse events. Conclusions ECT may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviors are refractory to medication management.

Electroconvulsive Therapy for Neuropsychiatric Symptoms due to Major Neurocognitive Disorder

“…The response rate of 76% for our primary outcome measure, the NPI-C total score, was somewhat lower than the 88% from the recent review 26 but still quite significant. Compared with the prospective study by Acharya et al, 25 which was similar in design, our results are consistent with their findings that NPI-total, NPI Agitation/Aggression, and NPI-behavioral dyscontrol substantially decreased in scores by the end of the ECT series. However, our results differ in that we found a concomitant significant reduction in CSDD scores but they did not, although it was close to statistical significance in their study.…”

Electroconvulsive Therapy for Neuropsychiatric Symptoms due to Major Neurocognitive Disorder

“…The response rate of 76% for our primary outcome measure, the NPI-C total score, was somewhat lower than the 88% from the recent review 26 but still quite significant. Compared with the prospective study by Acharya et al, 25 which was similar in design, our results are consistent with their findings that NPI-total, NPI Agitation/Aggression, and NPI-behavioral dyscontrol substantially decreased in scores by the end of the ECT series. However, our results differ in that we found a concomitant significant reduction in CSDD scores but they did not, although it was close to statistical significance in their study.…”

Clinical Effectiveness and Tolerability of Electroconvulsive Therapy in Patients with Neuropsychiatric Symptoms of Dementia

“…In 2 cases of comorbid mania and 4 cases of comorbid schizophrenia or schizoaffective disorder, the improvement was also apparent in the manic and primary psychotic symptoms. The results of this study support previous literature [13, 17–19] demonstrating the effectiveness of acute course of ECT in treating NPS of dementia in patients with and without pre-existing psychiatric disorders. Further, this study adds that ECT can be a viable treatment option for maintenance of remission from NPS in patients with dementia.…”

Untitled

“…Consistent with those findings in a more recent study, encouraging results from the use of ECT were reported by Acharya et al (2015) who followed a group of 23 individuals receiving ECT as the primary intervention to address agitation and aggression. It was found that a total of 87% of the participants tolerated the procedure well and experienced statistically significant reduction in aggression and agitation from baseline.…”

Electroconvulsive Therapy for Neuropsychiatric Symptoms due to Major Neurocognitive Disorder

“…The response rate of 76% for our primary outcome measure, the NPI-C total score, was somewhat lower than the 88% from the recent review 26 but still quite significant. Compared with the prospective study by Acharya et al, 25 which was similar in design, our results are consistent with their findings that NPI-total, NPI Agitation/Aggression, and NPI-behavioral dyscontrol substantially decreased in scores by the end of the ECT series. However, our results differ in that we found a concomitant significant reduction in CSDD scores but they did not, although it was close to statistical significance in their study.…”

Clinical Effectiveness and Tolerability of Electroconvulsive Therapy in Patients with Neuropsychiatric Symptoms of Dementia

“…In 2 cases of comorbid mania and 4 cases of comorbid schizophrenia or schizoaffective disorder, the improvement was also apparent in the manic and primary psychotic symptoms. The results of this study support previous literature [13, 17–19] demonstrating the effectiveness of acute course of ECT in treating NPS of dementia in patients with and without pre-existing psychiatric disorders. Further, this study adds that ECT can be a viable treatment option for maintenance of remission from NPS in patients with dementia.…”

Untitled

“…Consistent with those findings in a more recent study, encouraging results from the use of ECT were reported by Acharya et al (2015) who followed a group of 23 individuals receiving ECT as the primary intervention to address agitation and aggression. It was found that a total of 87% of the participants tolerated the procedure well and experienced statistically significant reduction in aggression and agitation from baseline.…”

Electroconvulsive Therapy for Neuropsychiatric Symptoms due to Major Neurocognitive Disorder

“…The response rate of 76% for our primary outcome measure, the NPI-C total score, was somewhat lower than the 88% from the recent review 26 but still quite significant. Compared with the prospective study by Acharya et al, 25 which was similar in design, our results are consistent with their findings that NPI-total, NPI Agitation/Aggression, and NPI-behavioral dyscontrol substantially decreased in scores by the end of the ECT series. However, our results differ in that we found a concomitant significant reduction in CSDD scores but they did not, although it was close to statistical significance in their study.…”

Clinical Effectiveness and Tolerability of Electroconvulsive Therapy in Patients with Neuropsychiatric Symptoms of Dementia

“…In 2 cases of comorbid mania and 4 cases of comorbid schizophrenia or schizoaffective disorder, the improvement was also apparent in the manic and primary psychotic symptoms. The results of this study support previous literature [13, 17–19] demonstrating the effectiveness of acute course of ECT in treating NPS of dementia in patients with and without pre-existing psychiatric disorders. Further, this study adds that ECT can be a viable treatment option for maintenance of remission from NPS in patients with dementia.…”

Untitled

“…Consistent with those findings in a more recent study, encouraging results from the use of ECT were reported by Acharya et al (2015) who followed a group of 23 individuals receiving ECT as the primary intervention to address agitation and aggression. It was found that a total of 87% of the participants tolerated the procedure well and experienced statistically significant reduction in aggression and agitation from baseline.…”