V Rao1, C G Lyketsos. 1. Neuropsychiatry and Memory Group, Department of Psychiatry and Behavioral Sciences, School of Medicine, The John Hopkins University, Baltimore, MD 21287, USA.
Abstract
BACKGROUND: Major depression afflicts 20-25% of patients with dementia. Of these, about a third do not improve with antidepressant therapy and may be suitable candidates for electronconvulsive treatment (ECT). However, the use of ECT is dementia patients is concerning due to possible adverse effects on memory and cognition. Outcome studies of ECT in patients with primary dementia and depression are very rare. OBJECTIVE: To determine the effectiveness and complications of ECT treatment for depression in dementia. METHOD: A chart review was conducted of all 31 patients wit ha discharge diagnosis of 'Dementia with depression' treated with ECT at the Johns Hopkins Hospital, over a five-year period. Admission and discharge ratings were made on the Mini-Mental State Examination (MMSE) and the Montgomery-Asberg Depression Rating Scale (MADRS) as part of the clinical routine. RESULTS: All patients suffered from dementia: 55% had vascular dementia, 13% Alzheimer's disease, and 32% degenerative dementia of uncertain etiology. The admission MADRS mean score was 27.5 (SD 8.1) and the MMSE mean score was 18.8 (SD 5. 5). The patients received between 1 and 23 ECT treatments (mean 9, SD 5.7). At discharge, there was a statistically significant mean decline on the MADRS of 12.28 points (p<0.01). Forty percent had scores less than 10 (normal) on the MADRS. While 49% of patients developed delirium, by discharge there was also a significant mean increase (improvement) in MMSE of 1.62 points (p<0.02). CONCLUSIONS: ECT is an effective treatment for depression in dementia, leading to improvements in both mood and cognition. Multiple ECT treatments may be necessary before a significant improvement in mode is achieved. Copyright 2000 John Wiley & Sons, Ltd.
BACKGROUND: Major depression afflicts 20-25% of patients with dementia. Of these, about a third do not improve with antidepressant therapy and may be suitable candidates for electronconvulsive treatment (ECT). However, the use of ECT is dementiapatients is concerning due to possible adverse effects on memory and cognition. Outcome studies of ECT in patients with primary dementia and depression are very rare. OBJECTIVE: To determine the effectiveness and complications of ECT treatment for depression in dementia. METHOD: A chart review was conducted of all 31 patients wit ha discharge diagnosis of 'Dementia with depression' treated with ECT at the Johns Hopkins Hospital, over a five-year period. Admission and discharge ratings were made on the Mini-Mental State Examination (MMSE) and the Montgomery-Asberg Depression Rating Scale (MADRS) as part of the clinical routine. RESULTS: All patients suffered from dementia: 55% had vascular dementia, 13% Alzheimer's disease, and 32% degenerative dementia of uncertain etiology. The admission MADRS mean score was 27.5 (SD 8.1) and the MMSE mean score was 18.8 (SD 5. 5). The patients received between 1 and 23 ECT treatments (mean 9, SD 5.7). At discharge, there was a statistically significant mean decline on the MADRS of 12.28 points (p<0.01). Forty percent had scores less than 10 (normal) on the MADRS. While 49% of patients developed delirium, by discharge there was also a significant mean increase (improvement) in MMSE of 1.62 points (p<0.02). CONCLUSIONS: ECT is an effective treatment for depression in dementia, leading to improvements in both mood and cognition. Multiple ECT treatments may be necessary before a significant improvement in mode is achieved. Copyright 2000 John Wiley & Sons, Ltd.
Authors: Angela Y Liu; Tarek K Rajji; Daniel M Blumberger; Zafiris J Daskalakis; Benoit H Mulsant Journal: Am J Geriatr Psychiatry Date: 2013-07-23 Impact factor: 4.105
Authors: Laurel D Pellegrino; Matthew E Peters; Constantine G Lyketsos; Christopher M Marano Journal: Curr Psychiatry Rep Date: 2013-09 Impact factor: 5.285
Authors: Deepa Acharya; David G Harper; Eric D Achtyes; Stephen J Seiner; Jack A Mahdasian; Louis J Nykamp; Lesley Adkison; Lori Van der Schuur White; Shawn M McClintock; Manjola Ujkaj; Donald A Davidoff; Brent P Forester Journal: Int J Geriatr Psychiatry Date: 2014-05-16 Impact factor: 3.485