EVIDENCE FOR ELECTROCONVULSIVE THERAPY (ECT) IN THE TREATMENT OF INTRACTABLE BEHAVIORAL SYMPTOMS OF DEMENTIA (BPSD): A SYSTEMATIC REVIEW

Abstract

Introduction Affecting 5.8?million individuals in the U.S. alone, the impact of Alzheimer's disease (AD) is several-fold; it increases patient morbidity and mortality, contributes to caregiver burden, increases public health burden, and comes at a staggering combined cost of over half a trillion dollars per year in health care and unpaid caregiving. Unfortunately, the behavioral symptoms of dementia (BPSD) such as agitation and aggression that largely contribute to the morbidity and burden of the disease remain neglected in the sphere of research. As the number of patients impacted by this disease rises to a predicted 13.8?million by 2050, the need for novel interventions to mitigate these BPSD contributing to the AD epidemic remains unmet. Current non-pharmacological interventions require substantial time to take effect and do not address the most severe, treatment refractory cases of BPSD. Pharmacological interventions, on the other hand, most commonly antipsychotics, have limited efficacy and are linked to substantial risks that elevate patient mortality. The limitations of these existing interventions have prompted the search for faster, safer, and more effective methods of managing BPSD in the AD population. In the past few decades, there has been growing evidence to support electroconvulsive therapy (ECT) as a safe and effective treatment to mitigate agitation in AD patients who are refractory to traditional interventions. This poster reports the results from a systematic review of the current evidence for ECT as an intervention for the mitigation of intractable BPSD in AD patients. Methods The authors conducted a literature search on Google Scholar, Medline, PubMed, and PsychInfo of the following search terms: “ECT aggression dementia,” “ECT Behavior and Psychological Symptoms of Dementia,” and “ECT BPSD.” The term “dementia” is also interchanged with “Major Neurocognitive Disorder.” The timeline for these searches was restricted to the past 30?years, allowing a list of publications between 1989-2019 to populate. Papers with only abstracts available were excluded, as were any duplicates between the searches. Results The authors reviewed 17 papers with a total (N) of 181 patients diagnosed with dementia and exhibiting severe agitation and aggression. These patients received various types of electroconvulsive therapy including: brief pulse (>0.5 msec) bitemporal (BP-BT), brief pulse right unilateral (BP-RUL) and ultrabrief pulse ( Conclusions This review of the current evidence for ECT in the treatment of severe agitation and aggression in AD, increasingly apparent is the large body of evidence for the efficacy of ECT for this indication. This review has brought to attention, however, the lack of safety data to accompany these findings on efficacy. As future prospective studies are developed to address this area of research with more robust parameters and objective scales, the studies reviewed thus far indicate a favorable risk/benefit ratio for the use of ECT in managing treatment refractory BPSD in patients with AD. This research was funded by: The National Institute of Aging (NIA 1 R01 AG061100-01)