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
Hauptverfasser: 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.
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container_end_page 273
container_issue 3
container_start_page 265
container_title International journal of geriatric psychiatry
container_volume 30
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
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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 &lt; 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 &amp; 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 &amp; Sons, Ltd.</rights><rights>Copyright Wiley Subscription Services, Inc. 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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 &lt; 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. 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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 &lt; 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 &amp; 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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