Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia
Objective Agitation and aggression are among the most frequent and disruptive behavioral complications of dementia that contribute to increased cost of care, hospitalization, caregiver burden, and risk of premature institutionalization. This current study examined the safety and efficacy of electroc...
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Veröffentlicht in: | International journal of geriatric psychiatry 2015-03, Vol.30 (3), p.265-273 |
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container_title | International journal of geriatric psychiatry |
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creator | Acharya, Deepa Harper, David G. Achtyes, Eric D. Seiner, Stephen J. Mahdasian, Jack A. Nykamp, Louis J. Adkison, Lesley Van der Schuur White, Lori McClintock, Shawn M. Ujkaj, Manjola Davidoff, Donald A. Forester, Brent P. |
description | Objective
Agitation and aggression are among the most frequent and disruptive behavioral complications of dementia that contribute to increased cost of care, hospitalization, caregiver burden, and risk of premature institutionalization. This current study examined the safety and efficacy of electroconvulsive therapy (ECT) as a treatment for behavioral disturbances in dementia. We hypothesized that ECT would result in reduced agitated and aggressive behaviors between baseline and discharge.
Methods
Twenty‐three participants admitted to McLean Hospital (Belmont, MA, USA) and Pine Rest Christian Mental Health Services (Grand Rapids, MI, USA), with a diagnosis of dementia who were referred for ECT to treat agitation and/or aggression, were enrolled in the study. We administered the Cohen‐Mansfield Agitation Inventory–Short Form, Neuropsychiatric Inventory–Nursing Home Version, Cornell Scale for Depression in Dementia, and the Clinical Global Impression Scale at baseline, during, and after the ECT course.
Results
Regression analyses revealed a significant decrease from baseline to discharge on the Cohen‐Mansfield Agitation Inventory (F(4,8) = 13.3; p = 0.006) and Neuropsychiatric Inventory (F(4,31) = 14.6; p |
doi_str_mv | 10.1002/gps.4137 |
format | Article |
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Agitation and aggression are among the most frequent and disruptive behavioral complications of dementia that contribute to increased cost of care, hospitalization, caregiver burden, and risk of premature institutionalization. This current study examined the safety and efficacy of electroconvulsive therapy (ECT) as a treatment for behavioral disturbances in dementia. We hypothesized that ECT would result in reduced agitated and aggressive behaviors between baseline and discharge.
Methods
Twenty‐three participants admitted to McLean Hospital (Belmont, MA, USA) and Pine Rest Christian Mental Health Services (Grand Rapids, MI, USA), with a diagnosis of dementia who were referred for ECT to treat agitation and/or aggression, were enrolled in the study. We administered the Cohen‐Mansfield Agitation Inventory–Short Form, Neuropsychiatric Inventory–Nursing Home Version, Cornell Scale for Depression in Dementia, and the Clinical Global Impression Scale at baseline, during, and after the ECT course.
Results
Regression analyses revealed a significant decrease from baseline to discharge on the Cohen‐Mansfield Agitation Inventory (F(4,8) = 13.3; p = 0.006) and Neuropsychiatric Inventory (F(4,31) = 14.6; p < 0.001). There was no statistically significant change in scores on the Cornell Scale for Depression in Dementia. The Clinical Global Impression scores on average changed from a rating of “markedly agitated/aggressive” at baseline to “borderline agitated/aggressive” at discharge. Treatment with ECT was well tolerated by most participants; discontinuation of ECT occurred for two participants because of recurrence of agitation and for three participants because of adverse events.
Conclusions
Electroconvulsive therapy may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviors are refractory to medication management. Copyright © 2014 John Wiley & Sons, Ltd.</description><identifier>ISSN: 0885-6230</identifier><identifier>EISSN: 1099-1166</identifier><identifier>DOI: 10.1002/gps.4137</identifier><identifier>PMID: 24838521</identifier><identifier>CODEN: IJGPES</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Aged ; Aged, 80 and over ; aggression ; Aggression - psychology ; Aggressiveness ; agitation ; Dementia ; Dementia - psychology ; Dementia - therapy ; ECT ; Electroconvulsive therapy ; Electroconvulsive Therapy - adverse effects ; Electroconvulsive Therapy - methods ; Electroconvulsive Therapy - psychology ; Female ; Geriatric psychiatry ; Humans ; Male ; Mental depression ; Mental health care ; Psychomotor Agitation - etiology ; Psychomotor Agitation - therapy ; Psychotropic Drugs - therapeutic use ; Regression Analysis ; Risk assessment</subject><ispartof>International journal of geriatric psychiatry, 2015-03, Vol.30 (3), p.265-273</ispartof><rights>Copyright © 2014 John Wiley & Sons, Ltd.</rights><rights>Copyright Wiley Subscription Services, Inc. Mar 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5797-7b48db8e9d08c5a55d356e84148eb040f8d64a53ea4c02edfd3f95c3909a0a8d3</citedby><orcidid>0000-0001-8939-1535</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fgps.4137$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fgps.4137$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,776,780,881,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24838521$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Acharya, Deepa</creatorcontrib><creatorcontrib>Harper, David G.</creatorcontrib><creatorcontrib>Achtyes, Eric D.</creatorcontrib><creatorcontrib>Seiner, Stephen J.</creatorcontrib><creatorcontrib>Mahdasian, Jack A.</creatorcontrib><creatorcontrib>Nykamp, Louis J.</creatorcontrib><creatorcontrib>Adkison, Lesley</creatorcontrib><creatorcontrib>Van der Schuur White, Lori</creatorcontrib><creatorcontrib>McClintock, Shawn M.</creatorcontrib><creatorcontrib>Ujkaj, Manjola</creatorcontrib><creatorcontrib>Davidoff, Donald A.</creatorcontrib><creatorcontrib>Forester, Brent P.</creatorcontrib><title>Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia</title><title>International journal of geriatric psychiatry</title><addtitle>Int J Geriatr Psychiatry</addtitle><description>Objective
Agitation and aggression are among the most frequent and disruptive behavioral complications of dementia that contribute to increased cost of care, hospitalization, caregiver burden, and risk of premature institutionalization. This current study examined the safety and efficacy of electroconvulsive therapy (ECT) as a treatment for behavioral disturbances in dementia. We hypothesized that ECT would result in reduced agitated and aggressive behaviors between baseline and discharge.
Methods
Twenty‐three participants admitted to McLean Hospital (Belmont, MA, USA) and Pine Rest Christian Mental Health Services (Grand Rapids, MI, USA), with a diagnosis of dementia who were referred for ECT to treat agitation and/or aggression, were enrolled in the study. We administered the Cohen‐Mansfield Agitation Inventory–Short Form, Neuropsychiatric Inventory–Nursing Home Version, Cornell Scale for Depression in Dementia, and the Clinical Global Impression Scale at baseline, during, and after the ECT course.
Results
Regression analyses revealed a significant decrease from baseline to discharge on the Cohen‐Mansfield Agitation Inventory (F(4,8) = 13.3; p = 0.006) and Neuropsychiatric Inventory (F(4,31) = 14.6; p < 0.001). There was no statistically significant change in scores on the Cornell Scale for Depression in Dementia. The Clinical Global Impression scores on average changed from a rating of “markedly agitated/aggressive” at baseline to “borderline agitated/aggressive” at discharge. Treatment with ECT was well tolerated by most participants; discontinuation of ECT occurred for two participants because of recurrence of agitation and for three participants because of adverse events.
Conclusions
Electroconvulsive therapy may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviors are refractory to medication management. Copyright © 2014 John Wiley & Sons, Ltd.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>aggression</subject><subject>Aggression - psychology</subject><subject>Aggressiveness</subject><subject>agitation</subject><subject>Dementia</subject><subject>Dementia - psychology</subject><subject>Dementia - therapy</subject><subject>ECT</subject><subject>Electroconvulsive therapy</subject><subject>Electroconvulsive Therapy - adverse effects</subject><subject>Electroconvulsive Therapy - methods</subject><subject>Electroconvulsive Therapy - psychology</subject><subject>Female</subject><subject>Geriatric psychiatry</subject><subject>Humans</subject><subject>Male</subject><subject>Mental depression</subject><subject>Mental health care</subject><subject>Psychomotor Agitation - etiology</subject><subject>Psychomotor Agitation - therapy</subject><subject>Psychotropic Drugs - therapeutic use</subject><subject>Regression Analysis</subject><subject>Risk assessment</subject><issn>0885-6230</issn><issn>1099-1166</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkktv1DAUhS0EokNB4hegSGzYpPj92CBBBQNSVZA6wA7LE9-kLpl4sJOB-fc4tAyPDayurfP5XN3rg9BDgk8IxvRpt80nnDB1Cy0INqYmRMrbaIG1FrWkDB-hezlfYVw0ou-iI8o104KSBfp04VoY95UbfDWNoQ_lHNvKNdMIFfTQjCk2cdhNfQ47qMZLSG67r9qYKteF0Y0hDj8eu65LkPN8DUPlYQPDGNx9dKd1fYYHN_UYvX_1cnX6uj57u3xz-vysboQyqlZrrv1ag_FYN8IJ4ZmQoDnhGtaY41Z7yZ1g4HiDKfjWs9aIhhlsHHbas2P07Np3O6034JvSPLneblPYuLS30QX7pzKES9vFneWCcqpVMXhyY5DilwnyaDchN9D3boA4ZUukotgoWrb5b1RiZjQV5D_Q0p5RyXRBH_-FXsUpDWVpM4WlIEKKQj36fc7DgD8_tAD1NfA19LA_6ATbOSi2BMXOQbHLdxdz_cWHPMK3A-_SZysVU8J-PF9aqj6szPnqhaXsO5flv5w</recordid><startdate>201503</startdate><enddate>201503</enddate><creator>Acharya, Deepa</creator><creator>Harper, David G.</creator><creator>Achtyes, Eric D.</creator><creator>Seiner, Stephen J.</creator><creator>Mahdasian, Jack A.</creator><creator>Nykamp, Louis J.</creator><creator>Adkison, Lesley</creator><creator>Van der Schuur White, Lori</creator><creator>McClintock, Shawn M.</creator><creator>Ujkaj, Manjola</creator><creator>Davidoff, Donald A.</creator><creator>Forester, Brent P.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><scope>7T2</scope><scope>7U1</scope><scope>7U2</scope><scope>C1K</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8939-1535</orcidid></search><sort><creationdate>201503</creationdate><title>Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia</title><author>Acharya, Deepa ; Harper, David G. ; Achtyes, Eric D. ; Seiner, Stephen J. ; Mahdasian, Jack A. ; Nykamp, Louis J. ; Adkison, Lesley ; Van der Schuur White, Lori ; McClintock, Shawn M. ; Ujkaj, Manjola ; Davidoff, Donald A. ; Forester, Brent P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5797-7b48db8e9d08c5a55d356e84148eb040f8d64a53ea4c02edfd3f95c3909a0a8d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>aggression</topic><topic>Aggression - psychology</topic><topic>Aggressiveness</topic><topic>agitation</topic><topic>Dementia</topic><topic>Dementia - psychology</topic><topic>Dementia - therapy</topic><topic>ECT</topic><topic>Electroconvulsive therapy</topic><topic>Electroconvulsive Therapy - adverse effects</topic><topic>Electroconvulsive Therapy - methods</topic><topic>Electroconvulsive Therapy - psychology</topic><topic>Female</topic><topic>Geriatric psychiatry</topic><topic>Humans</topic><topic>Male</topic><topic>Mental depression</topic><topic>Mental health care</topic><topic>Psychomotor Agitation - etiology</topic><topic>Psychomotor Agitation - therapy</topic><topic>Psychotropic Drugs - therapeutic use</topic><topic>Regression Analysis</topic><topic>Risk assessment</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Acharya, Deepa</creatorcontrib><creatorcontrib>Harper, David G.</creatorcontrib><creatorcontrib>Achtyes, Eric D.</creatorcontrib><creatorcontrib>Seiner, Stephen J.</creatorcontrib><creatorcontrib>Mahdasian, Jack A.</creatorcontrib><creatorcontrib>Nykamp, Louis J.</creatorcontrib><creatorcontrib>Adkison, Lesley</creatorcontrib><creatorcontrib>Van der Schuur White, Lori</creatorcontrib><creatorcontrib>McClintock, Shawn M.</creatorcontrib><creatorcontrib>Ujkaj, Manjola</creatorcontrib><creatorcontrib>Davidoff, Donald A.</creatorcontrib><creatorcontrib>Forester, Brent P.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Risk Abstracts</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International journal of geriatric psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Acharya, Deepa</au><au>Harper, David G.</au><au>Achtyes, Eric D.</au><au>Seiner, Stephen J.</au><au>Mahdasian, Jack A.</au><au>Nykamp, Louis J.</au><au>Adkison, Lesley</au><au>Van der Schuur White, Lori</au><au>McClintock, Shawn M.</au><au>Ujkaj, Manjola</au><au>Davidoff, Donald A.</au><au>Forester, Brent P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia</atitle><jtitle>International journal of geriatric psychiatry</jtitle><addtitle>Int J Geriatr Psychiatry</addtitle><date>2015-03</date><risdate>2015</risdate><volume>30</volume><issue>3</issue><spage>265</spage><epage>273</epage><pages>265-273</pages><issn>0885-6230</issn><eissn>1099-1166</eissn><coden>IJGPES</coden><abstract>Objective
Agitation and aggression are among the most frequent and disruptive behavioral complications of dementia that contribute to increased cost of care, hospitalization, caregiver burden, and risk of premature institutionalization. This current study examined the safety and efficacy of electroconvulsive therapy (ECT) as a treatment for behavioral disturbances in dementia. We hypothesized that ECT would result in reduced agitated and aggressive behaviors between baseline and discharge.
Methods
Twenty‐three participants admitted to McLean Hospital (Belmont, MA, USA) and Pine Rest Christian Mental Health Services (Grand Rapids, MI, USA), with a diagnosis of dementia who were referred for ECT to treat agitation and/or aggression, were enrolled in the study. We administered the Cohen‐Mansfield Agitation Inventory–Short Form, Neuropsychiatric Inventory–Nursing Home Version, Cornell Scale for Depression in Dementia, and the Clinical Global Impression Scale at baseline, during, and after the ECT course.
Results
Regression analyses revealed a significant decrease from baseline to discharge on the Cohen‐Mansfield Agitation Inventory (F(4,8) = 13.3; p = 0.006) and Neuropsychiatric Inventory (F(4,31) = 14.6; p < 0.001). There was no statistically significant change in scores on the Cornell Scale for Depression in Dementia. The Clinical Global Impression scores on average changed from a rating of “markedly agitated/aggressive” at baseline to “borderline agitated/aggressive” at discharge. Treatment with ECT was well tolerated by most participants; discontinuation of ECT occurred for two participants because of recurrence of agitation and for three participants because of adverse events.
Conclusions
Electroconvulsive therapy may be a safe treatment option to reduce symptoms of agitation and aggression in patients with dementia whose behaviors are refractory to medication management. Copyright © 2014 John Wiley & Sons, Ltd.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>24838521</pmid><doi>10.1002/gps.4137</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-8939-1535</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Aged Aged, 80 and over aggression Aggression - psychology Aggressiveness agitation Dementia Dementia - psychology Dementia - therapy ECT Electroconvulsive therapy Electroconvulsive Therapy - adverse effects Electroconvulsive Therapy - methods Electroconvulsive Therapy - psychology Female Geriatric psychiatry Humans Male Mental depression Mental health care Psychomotor Agitation - etiology Psychomotor Agitation - therapy Psychotropic Drugs - therapeutic use Regression Analysis Risk assessment |
title | Safety and utility of acute electroconvulsive therapy for agitation and aggression in dementia |
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