Long Term Cognitive Impact of Electroconvulsive Therapy in Patients with Early Frontotemporal Lobar Degeneration

Abstract

Frontotemporal lobar degeneration (FTLD) is the umbrella term to describe several overlapping neurodegenerative syndromes including progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and behavioral variant frontotemporal dementia (bvFTD). Most patients with FTLD present initially with psychiatric symptoms such as apathy, depressed mood, and fatigue (often with a mild Parkinsonism) that almost always prove refractory to medication interventions and psychotherapy. Some patients may be recommended for electroconvulsive therapy (ECT), which in our clinical experience, is not effective and potentially harmful. Electroconvulsive therapy has a well-known risk of cognitive impairment and memory loss but the full impact and long-term effects of this intervention are not well studied in individuals with neurodegenerative disease.For this clinical case presentation, we will discuss the case of a 69-year-old left-handed female who presented to our memory and cognitive disorders clinic after several years of apathy, depressed mood, and irritability. Due to the refractory nature of her treatment, she had undergone several rounds to ECT; an intervention that did not help her behavioral symptoms and appeared to accelerate her cognitive decline. Volumetric MRI and neuropsychological testing confirmed the diagnosis of corticobasal degeneration, a FTLD spectrum disease. Implications for course and management of this patient's neurodegenerative process, particularly neuropsychiatric sequelae, will be discussed.