The use of electroconvulsive therapy in dementia with behavioral disturbances

Abstract

As many as 50% of demented patients are agitated at some point during their illness and up to a third may became physically aggressive toward caregivers. First-line treatment approaches for behavioral disturbances in dementia are psychosocial and not pharmacological. Pharmacological interventions are second line, but the use of most medications is off label and complicated by potentially serious side effects. There is an absence of evidence-based data as to the use of ECT to treat refractory behavioral disturbances in dementia, although a large body of case reports and case series points to its possible safety and efficacy. In the absence of clear evidence for its efficacy and indications for use, we have developed a clinical guide to inform the use of ECT in this population.