The benefits and risks of ECT for patients with primary dementia who also suffer from depression

Abstract

Background Major depression afflicts 20–25% of patients with dementia. Of these, about a third do not improve with antidepressant therapy and may be suitable candidates for electronconvulsive treatment (ECT). However, the use of ECT is dementia patients is concerning due to possible adverse effects on memory and cognition. Outcome studies of ECT in patients with primary dementia and depression are very rare. Objective To determine the effectiveness and complications of ECT treatment for depression in dementia. Method A chart review was conducted of all 31 patients wit ha discharge diagnosis of ‘Dementia with depression’ treated with ECT at the Johns Hopkins Hospital, over a five‐year period. Admission and discharge ratings were made on the Mini‐Mental State Examination (MMSE) and the Montgomery–Asberg Depression Rating Scale (MADRS) as part of the clinical routine. Results All patients suffered from dementia: 55% had vascular dementia, 13% Alzheimer's disease, and 32% degenerative dementia of uncertain etiology. The admission MADRS mean score was 27.5 (SD 8.1) and the MMSE mean score was 18.8 (SD 5.5). The patients received between 1 and 23 ECT treatments (mean 9, SD 5.7). At discharge, there was a statistically significant mean decline on the MADRS of 12.28 points (p<0.01). Forty percent had scores less than 10 (normal) on the MADRS. While 49% of patients developed delirium, by discharge there was also a significant mean increase (improvement) in MMSE of 1.62 points (p<0.02). Conclusions ECT is an effective treatment for depression in dementia, leading to improvements in both mood and cognition. Multiple ECT treatments may be necessary before a significant improvement in mode is achieved. Copyright © 2000 John Wiley & Sons, Ltd.

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

“…On the basis of the data from participants who completed the neurocognitive measures before and after ECT, there was an approximate two-point increase in the average MMSE score and a 10-point increase in the average SIB score from baseline to discharge. This is consistent with a previous study by Rao and Lyketsos (2000) who found a modest improvement in MMSE average scores of 1.6 points from baseline to discharge in patients with dementia treated with ECT for depression. Hausner et al (2011) demonstrated stability of the MMSE total score in patients with dementia treated with ECT for depression, from baseline to 6 weeks and 6 months posttreatment, suggesting that the global cognitive function neither improved nor declined across time.…”

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

“…On the basis of the data from participants who completed the neurocognitive measures before and after ECT, there was an approximate two-point increase in the average MMSE score and a 10-point increase in the average SIB score from baseline to discharge. This is consistent with a previous study by Rao and Lyketsos (2000) who found a modest improvement in MMSE average scores of 1.6 points from baseline to discharge in patients with dementia treated with ECT for depression. Hausner et al (2011) demonstrated stability of the MMSE total score in patients with dementia treated with ECT for depression, from baseline to 6 weeks and 6 months posttreatment, suggesting that the global cognitive function neither improved nor declined across time.…”

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

“…Many cases of elderly patients with dementia receiving ECT for major depression have been described. 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.…”

Right unilateral versus bilateral formula‐based electroconvulsive therapy in the treatment of major depression in elderly patients: a randomised, open label, pilot controlled trial

“…demonstrated an improvement in overall cognitive performance, verbal auditory memory and verbal fluency after ECT in their elderly population. There are also reports of cognitive improvement after ECT in patients with depression and cognitive impaired 44,45 . These results are therefore very encouraging for further exploration of this issue.…”

“…There are also reports of cognitive improvement after ECT in patients with depression and cognitive impaired. 44,45 These results are therefore very encouraging for further exploration of this issue.…”

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

“…On the basis of the data from participants who completed the neurocognitive measures before and after ECT, there was an approximate two-point increase in the average MMSE score and a 10-point increase in the average SIB score from baseline to discharge. This is consistent with a previous study by Rao and Lyketsos (2000) who found a modest improvement in MMSE average scores of 1.6 points from baseline to discharge in patients with dementia treated with ECT for depression. Hausner et al (2011) demonstrated stability of the MMSE total score in patients with dementia treated with ECT for depression, from baseline to 6 weeks and 6 months posttreatment, suggesting that the global cognitive function neither improved nor declined across time.…”

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

“…Many cases of elderly patients with dementia receiving ECT for major depression have been described. 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.…”

Right unilateral versus bilateral formula‐based electroconvulsive therapy in the treatment of major depression in elderly patients: a randomised, open label, pilot controlled trial

“…demonstrated an improvement in overall cognitive performance, verbal auditory memory and verbal fluency after ECT in their elderly population. There are also reports of cognitive improvement after ECT in patients with depression and cognitive impaired 44,45 . These results are therefore very encouraging for further exploration of this issue.…”

“…There are also reports of cognitive improvement after ECT in patients with depression and cognitive impaired. 44,45 These results are therefore very encouraging for further exploration of this issue.…”

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

“…On the basis of the data from participants who completed the neurocognitive measures before and after ECT, there was an approximate two-point increase in the average MMSE score and a 10-point increase in the average SIB score from baseline to discharge. This is consistent with a previous study by Rao and Lyketsos (2000) who found a modest improvement in MMSE average scores of 1.6 points from baseline to discharge in patients with dementia treated with ECT for depression. Hausner et al (2011) demonstrated stability of the MMSE total score in patients with dementia treated with ECT for depression, from baseline to 6 weeks and 6 months posttreatment, suggesting that the global cognitive function neither improved nor declined across time.…”

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

“…Many cases of elderly patients with dementia receiving ECT for major depression have been described. 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.…”

Right unilateral versus bilateral formula‐based electroconvulsive therapy in the treatment of major depression in elderly patients: a randomised, open label, pilot controlled trial

“…demonstrated an improvement in overall cognitive performance, verbal auditory memory and verbal fluency after ECT in their elderly population. There are also reports of cognitive improvement after ECT in patients with depression and cognitive impaired 44,45 . These results are therefore very encouraging for further exploration of this issue.…”

“…There are also reports of cognitive improvement after ECT in patients with depression and cognitive impaired. 44,45 These results are therefore very encouraging for further exploration of this issue.…”