Electroconvulsive Therapy for Neuropsychiatric Symptoms due to Major Neurocognitive Disorder

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Peter Chan ◽  
Robyn E. Waxman ◽  
Simon Woo ◽  
Claire Docherty ◽  
Kaveh Rayani ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Neuropsychiatric Symptoms ◽  
Neurocognitive Disorder

scholarly journals 302 - The Effectiveness and Safety of Electroconvulsive Therapy for Treatment Refractory Agitation or Aggression in Major Neurocognitive Disorder

2020 ◽  
Vol 32 (S1) ◽  
pp. 58-58
Author(s):  
Simon Woo ◽  
Peter Chan ◽  
Robyn E Waxman ◽  
Sarah Elmi ◽  
Mafalda Musacchio ◽  
...  
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Symptom Clusters ◽  
Decision Makers ◽  
Neurocognitive Disorder ◽  
Increased Risk ◽  
Valuable Treatment ◽  
Psychiatric Conditions ◽  
Treatment Refractory ◽  
Refractory Symptom ◽  
Inpatient Units

Introduction:Fifty to ninety percent of individuals with Major Neurocognitive Disorder (MNCD) have Neuropsychiatric Symptoms (NPS)1. Agitation and aggression are amongst the most persistent and treatment-refractory symptom clusters. Patients with these NPS are associated with increased risk of institutionalization, psychotropic medication use, caregiver burden, and mortality2.Safe and effective treatments for NPS are lacking. Consensus guidelines emphasize the initial use of non-pharmacologic approaches though supportive evidence is limited3.Extensive research has established the safety and efficacy of ECT in elderly patients with depression and other psychiatric conditions6. Clinical experience suggests that ECT is a valuable treatment option in MNCD-related treatment refractory NPS cases7-10. However, data supporting the efficacy and safety of this practice is scant.Materials and Method:Patients admitted to the geriatric psychiatry inpatient units who meet the inclusion criteria, were recruited from 2 Vancouver sites and 3 unit at Ontario Shores. These patients had an anesthesia consultation to evaluate their safety of going through ECT. Consent was obtained from their substitute decision makers. All patients enrolled are already on psychotropic medications.

scholarly journals Complete cognitive recovery in a severe case of anti-N-methyl-d-aspartate receptor encephalitis treated with electroconvulsive therapy

2020 ◽  
Vol 13 (2) ◽  
pp. e233772
Author(s):  
Cæcilie Leding ◽  
Lisbet Marstrand ◽  
Anders Jorgensen
Keyword(s):  
Nmda Receptor ◽  
Electroconvulsive Therapy ◽  
Neuropsychiatric Symptoms ◽  
Behavioural Change ◽  
Severe Case ◽  
Cognitive Outcome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cognitive Domains ◽  
Nmda Receptor Encephalitis

Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis usually presents with prominent neuropsychiatric symptoms and many patients experience cognitive sequelae. Electroconvulsive therapy (ECT) has been suggested as a part of the treatment, particularly for catatonia, but concerns that ECT may worsen the cognitive function and long-term outcome may limit its use. We present a case of anti-NMDA receptor encephalitis with severe neuropsychiatric manifestations including refractory catatonia and behavioural change. A pre-ECT neuropsychological assessment revealed dysfunction in multiple cognitive domains in spite of intensive pharmacological treatment. Twenty days after the ninth and last ECT treatment, the patient underwent the same neuropsychological tests, which showed normalised test results within all cognitive domains and no need of rehabilitation. The case demonstrates that the use of ECT in anti-NMDA receptor encephalitis with severe pretreatment cognitive dysfunction can be associated with a highly favourable cognitive outcome.

Ultrabrief Right Unilateral Electroconvulsive Therapy for the Treatment of the Neuropsychiatric Symptoms of Dementia with Lewy Bodies

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Adriana P. Hermida ◽  
Evelina Sterina ◽  
P. Parker Schwab ◽  
Cody Michael Browning ◽  
Hannah M. Chapman ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Dementia With Lewy Bodies ◽  
Neuropsychiatric Symptoms ◽  
Lewy Bodies

scholarly journals Neuropsychiatric Symptoms in Mild Cognitive Impairment

2017 ◽  
Vol 62 (3) ◽  
pp. 161-169 ◽  
Author(s):  
Damien Gallagher ◽  
Corinne E. Fischer ◽  
Andrea Iaboni
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Neuropsychiatric Symptoms ◽  
Later Life ◽  
Neurocognitive Disorders ◽  
Prognostic Indicators ◽  
Neurocognitive Disorder ◽  
Clinical Stages ◽  
Before And After

Objective: Neuropsychiatric symptoms (NPS) may be the first manifestation of an underlying neurocognitive disorder. We undertook a review to provide an update on the epidemiology and etiological mechanisms of NPS that occur in mild cognitive impairment (MCI) and just before the onset of MCI. We discuss common clinical presentations and the implications for diagnosis and care. Method: The authors conducted a selective review of the literature regarding the emergence of NPS in late life, before and after the onset of MCI. We discuss recent publications that explore the epidemiology and etiological mechanisms of NPS in the earliest clinical stages of these disorders. Results: NPS have been reported in 35% to 85% of adults with MCI and also occur in advance of cognitive decline. The occurrence of NPS for the first time in later life should increase suspicion for an underlying neurocognitive disorder. The presenting symptom may provide a clue regarding the etiology of the underlying disorder, and the co-occurrence of NPS may herald a more accelerated cognitive decline. Conclusions: NPS are prevalent in the early clinical stages of neurocognitive disorders and can serve as both useful diagnostic and prognostic indicators. Recognition of NPS as early manifestations of neurocognitive disorders will become increasingly important as we move towards preventative strategies and disease-modifying treatments that may be most effective when deployed in the earliest stages of disease.

scholarly journals COVID-19 Crisis Effects on Caregiver Distress in Neurocognitive Disorder

2021 ◽  
Vol 79 (1) ◽  
pp. 459-466
Author(s):  
Panagiotis Alexopoulos ◽  
Rigas Soldatos ◽  
Evangelia Kontogianni ◽  
Maria Frouda ◽  
Souzana loanna Aligianni ◽  
...  
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Neurocognitive Disorder ◽  
Caregiver Distress ◽  
Impact Of Event Scale ◽  
Event Scale ◽  
Dementia Screening ◽  
Mental Reaction ◽  
Need For Support ◽  
The Relationship ◽  
Shed Light

Background: The outbreak of the COVID-19 pandemic seems to have mental health implications for both people with neurocognitive disorder and their caregivers. Objective: The study aimed to shed light on relations between caregiver mental reaction to the pandemic and caregiver distress related to neuropsychiatric symptoms, memory impairment progression, and functional impairment of people with neurocognitive disorder during the period of confinement in Greece. Methods: The study included caregivers of patients with mild (N = 13) and major (N = 54) neurocognitive disorder. The caregiver-based telephone interview was based on items of the neuropsychiatric inventory questionnaire, the AD8 Dementia Screening Instrument, and the Bristol Activities of Daily Living Scale. Regarding the mental impact of the COVID-19 crisis on caregivers, four single questions referring to their worries in the last seven days were posed, in addition to the scales Generalized Anxiety Disorder 7-Item (GAD-7) and the 22-item Impact of Event Scale-revised (IES-R). A stepwise linear regression model was employed for studying the relationship between caregiver distress and demographic and clinical data and caregiver mental reaction to COVID-19 pandemic outbreak. Results: Caregiver distress severity during the confinement period was influenced not only by memory deficits (p = 0.009) and neuropsychiatric symptoms (p < 0.001) of patients, but also by caregiver hyperarousal (p = 0.003) and avoidance symptoms (p = 0.033) and worries directly linked to the COVID-19 crisis (p = 0.022). Conclusion: These observations provide further evidence for the urgent need for support of caregivers of patients with neurocognitive disorder during the COVID-19 pandemic.

scholarly journals Electroconvulsive therapy in Parkinson´s disease

2015 ◽  
Vol 73 (10) ◽  
pp. 856-860 ◽  
Author(s):  
Humberto Calderón-Fajardo ◽  
Amin Cervantes-Arriaga ◽  
Rodrigo Llorens-Arenas ◽  
Jesús Ramírez-Bermudez ◽  
Ángel Ruiz-Chow ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Rating Scale ◽  
Neuropsychiatric Symptoms ◽  
Review Of The Literature ◽  
Scale Reduction ◽  
Brief Psychiatric Rating Scale ◽  
Psychiatric Rating ◽  
The Mean ◽  
Psychiatric Rating Scale ◽  
Therapy Sessions

Purpose To analyze the effectiveness of electroconvulsive therapy for the management of depression and/or psychosis refractory to drug therapy in patients with Parkinson disease.Methods A retrospective study was carried out including patients treated with electroconvulsive therapy during the period between 2002 and 2013. A review of the literature was performed.Results A total of 27 patients were included. In regards to the neuropsychiatric diagnosis, 14 patients had major depression, 12 patients had both psychosis and depression, and only one patient had isolated psychosis. The mean number of electroconvulsive therapy sessions was 12 ± 2.8. After electroconvulsive therapy, all patients showed a statistically significant improvement in the Brief Psychiatric Rating scale (reduction of 52% points) and Hamilton Depression Rating Scale (reduction of 50% points) independent of the presence of psychosis, depression or both.Conclusion Electroconvulsive therapy is effective for the treatment of refractory neuropsychiatric symptoms in Parkinson’s disease.

Electroconvulsive therapy (ECT) for treating agitation in dementia (major neurocognitive disorder) – a promising option

2017 ◽  
Vol 29 (5) ◽  
pp. 717-726 ◽  
Author(s):  
Oliver M. Glass ◽  
Brent P. Forester ◽  
Adriana P. Hermida
Keyword(s):  
Randomized Controlled Trial ◽  
Electroconvulsive Therapy ◽  
Rating Scales ◽  
Controlled Trial ◽  
Case Series ◽  
Small Sample ◽  
Control Group ◽  
Neurocognitive Disorder ◽  
Randomized Controlled ◽  
Wide Range

ABSTRACTBackground:Agitation in patients with dementia increases caretaker burden, increases healthcare costs, and worsens the patient's quality of life. Antipsychotic medications, commonly used for the treatment of agitation in patients with dementia have a box warning from the FDA for elevated mortality risk. Electroconvulsive therapy (ECT) has made significant advances over the past several years, and is efficacious in treating a wide range of psychiatric conditions. We provide a systematic review of published literature regarding the efficacy of ECT for the treatment of agitation in patients with dementia (major neurocognitive disorder).Methods:We searched PubMed, Medline, Google Scholar, UptoDate, Embase, and Cochrane for literature concerning ECT for treating agitation in dementia using the title search terms “ECT agitation dementia;” “ECT aggression dementia;” “ECT Behavior and Psychological Symptoms of Dementia;” and “ECT BPSD.” The term “dementia” was also interchanged with “Major Neurocognitive Disorder.” No time frame restriction was placed. We attempted to include all publications that were found to ensure a comprehensive review. We found 11 papers, with a total (N) of 216 patients.Results:Limited to case reports, case series, retrospective chart review, retrospective case-control, and an open label prospective study, ECT has demonstrated promising results in decreasing agitation in patients with dementia. Patients who relapsed were found to benefit from maintenance ECT.Conclusions:Available studies are often limited by concomitant psychotropic medications, inconsistent use of objective rating scales, short follow-up, lack of a control group, small sample sizes, and publication bias. A future randomized controlled trial will pose ethical and methodological challenges. A randomized controlled trial must carefully consider the definition of usual care as a comparison group. Well-documented prospective studies and/or additional case series with explicit selection criteria, a wide range of outcome measures, and less selection bias of the study sample that may favor treatment response, is warranted. ECT may be a promising option for the treatment of aggression and agitation in patients with severe dementia who are refractory to other treatment options, but the limitations of available studies suggest that a cautious approach to future randomized controlled trials is warranted.

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