Study data published in the American Journal of Geriatric Psychiatry support the efficacy and safety of electroconvulsive therapy (ECT) to reduce agitation and improve global functioning levels in patients with dementia.
Adriana P. Hermida, MD, and colleagues at the department of psychiatry and behavioral sciences, Emory University School of Medicine in Atlanta conducted a retrospective chart review of 60 elderly psychiatric inpatients with dementia who received ECT treatment after presenting with aggression or agitation. Aggression and agitation were measured before and after ECT with the Pittsburgh Agitation Scale (PAS). Additional study parameters included psychotropic medication use, the Global Assessment of Functioning, comorbid diagnoses, and psychiatric consult notes. The majority of patients had not responded to psychotropic medications prior to ECT referral.
All patients (mean age, 77.5±8.0 years; 75% women) experienced a significant PAS score decrease from baseline to discharge. Baseline mean PAS score (9.3±3.7) decreased to 2.5±2.8 and 1.5±2.3 after 3 and 6 ECT treatments, respectively.
The average change of PAS total represented an overall 88.5% reduction. Global Assessment of Functioning score increased significantly after ECT, from 20.8±4.9 to 34.5±4.4 (P <.0001). A decrease in number of psychotropic medications taken, from 6.0±1.6 to 4.9±1.6, was also observed at discharge (P <.001).
Most patients were discharged after receiving 4 to 6 inpatient ECT treatments. The most common adverse events were postictal agitation and mild confusion, observed in 6 patients following their first ECT session.
Oral olanzapine 5 mg given 30 minutes prior to subsequent ECT prevented recurrence.
No other major ECT-related medical complications were observed.
Limitations included reliance on a relatively small clinical sample and unavailability of cognitive function measures. Further research is necessary to explore the efficacy of continuation and maintenance ECT for patients with dementia. Overall, ECT was a safe treatment option for patients with dementia experiencing agitation or aggression, as well as for those with comorbid medical conditions.
Hermida AP, Tang Y, Glass O, Janjua AU, McDonald WM. Efficacy and safety of ECT for behavioral and psychological symptoms of dementia (BPSD): a retrospective chart review [published online September 26, 2019]. Am J Geriatr Psychiatry. doi:10.1016/j.jagp.2019.09.008