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OBJECTIVES: This study explores the association between baseline impaired global cognitive function and changes in global cognitive function and depression among geriatric patients undergoing acute course electroconvulsive therapy (ECT). DESIGN: Retrospective cohort study SETTING: Single freestanding psychiatric hospital PARTICIPANTS: Patients aged 50 and older receiving ECT INTERVENTIONS: 10 ECT treatments MEASUREMENTS: Cognitive assessments with the Montreal Cognitive Assessment (MoCA). Depression assessment with the Quick Inventory of Depressive Symptomatology Self Report 16 item scale (QIDS) RESULTS: Baseline and follow-up data were available for 684 patients. On average, patients with baseline normal cognition (MoCA ≥ 26; N = 371) had a decrease in MoCA of −1.44 ±0.26 points over the course of treatment, while those with baseline impaired global cognitive function (MoCA < 26; N = 313) had an increase in MoCA of 1.72±0.25 points. Baseline cognitive status was not associated with a differential response on the QIDS. CONCLUSIONS: Patients with baseline impaired global cognitive function did not demonstrate a worsening in cognition following ECT, and baseline global cognitive function was not associated with a differential change in depression with ECT. These results suggest that impaired global cognitive function should not be viewed as a contraindication to ECT in geriatric patients.

Objective There is limited information regarding the tolerability of electroconvulsive therapy (ECT) combined with pharmacotherapy in elderly adults with major depressive disorder (MDD). Addressing this gap, we report acute neurocognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study. Methods Elderly adults (age ≥60) with MDD received an acute course of 6 times seizure threshold right unilateral ultrabrief pulse (RUL-UB) ECT. Venlafaxine was initiated during the first treatment week and continued throughout the study. A comprehensive neurocognitive battery was administered at baseline and 72 hours following the last ECT session. Statistical significance was defined as a two-sided p-value of less than 0.05. Results A total of 240 elderly adults were enrolled. Neurocognitive performance acutely declined post ECT on measures of psychomotor and verbal processing speed, autobiographical memory consistency, short-term verbal recall and recognition of learned words, phonemic fluency, and complex visual scanning/cognitive flexibility. The magnitude of change from baseline to end for most neurocognitive measures was modest. Conclusion This is the first study to characterize the neurocognitive effects of combined RUL-UB ECT and venlafaxine in elderly adults with MDD and provides new evidence for the tolerability of RUL-UB ECT in an elderly sample. Of the cognitive domains assessed, only phonemic fluency, complex visual scanning, and cognitive flexibility qualitatively declined from low average to mildly impaired. While some acute changes in neurocognitive performance were statistically significant, the majority of the indices as based on the effect sizes remained relatively stable.

Introduction Affecting 5.8?million individuals in the U.S. alone, the impact of Alzheimer's disease (AD) is several-fold; it increases patient morbidity and mortality, contributes to caregiver burden, increases public health burden, and comes at a staggering combined cost of over half a trillion dollars per year in health care and unpaid caregiving. Unfortunately, the behavioral symptoms of dementia (BPSD) such as agitation and aggression that largely contribute to the morbidity and burden of the disease remain neglected in the sphere of research. As the number of patients impacted by this disease rises to a predicted 13.8?million by 2050, the need for novel interventions to mitigate these BPSD contributing to the AD epidemic remains unmet. Current non-pharmacological interventions require substantial time to take effect and do not address the most severe, treatment refractory cases of BPSD. Pharmacological interventions, on the other hand, most commonly antipsychotics, have limited efficacy and are linked to substantial risks that elevate patient mortality. The limitations of these existing interventions have prompted the search for faster, safer, and more effective methods of managing BPSD in the AD population. In the past few decades, there has been growing evidence to support electroconvulsive therapy (ECT) as a safe and effective treatment to mitigate agitation in AD patients who are refractory to traditional interventions. This poster reports the results from a systematic review of the current evidence for ECT as an intervention for the mitigation of intractable BPSD in AD patients. Methods The authors conducted a literature search on Google Scholar, Medline, PubMed, and PsychInfo of the following search terms: “ECT aggression dementia,” “ECT Behavior and Psychological Symptoms of Dementia,” and “ECT BPSD.” The term “dementia” is also interchanged with “Major Neurocognitive Disorder.” The timeline for these searches was restricted to the past 30?years, allowing a list of publications between 1989-2019 to populate. Papers with only abstracts available were excluded, as were any duplicates between the searches. Results The authors reviewed 17 papers with a total (N) of 181 patients diagnosed with dementia and exhibiting severe agitation and aggression. These patients received various types of electroconvulsive therapy including: brief pulse (>0.5 msec) bitemporal (BP-BT), brief pulse right unilateral (BP-RUL) and ultrabrief pulse ( Conclusions This review of the current evidence for ECT in the treatment of severe agitation and aggression in AD, increasingly apparent is the large body of evidence for the efficacy of ECT for this indication. This review has brought to attention, however, the lack of safety data to accompany these findings on efficacy. As future prospective studies are developed to address this area of research with more robust parameters and objective scales, the studies reviewed thus far indicate a favorable risk/benefit ratio for the use of ECT in managing treatment refractory BPSD in patients with AD. This research was funded by: The National Institute of Aging (NIA 1 R01 AG061100-01)

Introduction Alzheimer's disease (AD) is the most prevalent neurodegenerative disease of aging, affecting approximately 5.4 million individuals in the US, and predicted to increase to 13.8 million by 2050. Occurring in over 90% of AD patients, neuropsychiatric symptoms such as agitation, depression and apathy, contribute to caregiver burden and increase patient morbidity and mortality. With no FDA-approved options available, treatments for severe agitation in people with advanced dementia are limited, with modest evidence for efficacy and substantial safety concerns. Behavioral therapies are recommended as first-line treatments for agitation in AD; however, they require substantial time to take effect and may be less efficacious for the most severely agitated patients. Psychotropic medications, especially antipsychotics, are widely used off-label to treat agitation in AD even with documented limitations in efficacy and safety concerns. Therefore, new treatments for severe agitation in AD refractory to standard interventions are timely and warranted. Randomized controlled trials have demonstrated the safety and efficacy of electroconvulsive therapy (ECT) for the treatment of severe psychiatric disorders of late life, including depression, mania and psychosis. Recently, small open label studies suggest efficacy and safety of ECT for agitation in individuals with AD who are refractory to standard therapies. The present randomized controlled trial builds upon prior work and aims to determine the efficacy and safety of ECT for severe agitation in moderate to severe stage AD, while also examining the durability of the acute treatment effect in an exploratory maintenance naturalistic design. Methods We describe an NIA-funded multi-site, single blind, randomized trial of ECT plus usual care (UC) versus Simulated-ECT (S-ECT) plus UC. We will enroll 200 inpatients with severe agitation and moderate to severe dementia, who have not responded well to prior trials of psychotropic medications. Our primary efficacy outcome measure is the Cohen Mansfield Agitation Inventory (CMAI), and the Neuropsychiatric Inventory – Clinician Version (NPI-C), Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change Scale (ADCS-CGIC), and Pittsburgh Agitation Scale (PAS) will be secondary measures. Safety and tolerability will be assessed with the Severe Impairment Battery – 8 item (SIB-8), the Confusion Assessment Method (CAM), and adverse event monitoring. Results Preliminary open-label data from our team suggests acute ECT treatment is safe and effective in reducing agitation in this population as measured by the CMAI, PAS, CGI, and adverse event monitoring. A multi-site, prospective case series investigated ECT treatment in 23 consecutive inpatients with dementia and severe agitation who did not benefit from standard behavioral interventions and pharmacotherapy. Eighteen of the 23 subjects experienced a significant reduction in agitation from baseline to discharge on the CMAI. In a retrospective chart review study of 16 patients undergoing ECT for agitation related to AD, only two experienced more than transient confusion post-ECT that required treatment, and no other clinically significant adverse events were noted in this group. We hypothesize ECT+UC will be more efficacious in reducing severe agitation in AD subjects than S-ECT+UC, as measured by our primary and secondary efficacy measures, and that there will be no difference in tolerability/safety outcomes for ECT+UC and S-ECT+UC as measured by cognitive decline (SIB-8), development of delirium (CAM), and serious adverse event monitoring. Conclusions This innovative study will fill a gap in the current clinical practice of treating severe agitation in AD using a rigorous methodological approach thus providing evidence for a new therapeutic application (severe agitation in AD) of a well-studied, established, and safe treatment (ECT). Study findings may demonstrate support for a new therapeutic use of ECT for severe agitation in AD. Successful management of neuropsychiatric symptoms reduces long-term care placement, decreases the risk of mortality, and enhances patient and caregiver quality-of-life. Such an approach has the potential to offer enormous relief to the substantial socioeconomic burden of AD-related behavioral disturbances. This research was funded by National Institute of Aging R01 AG061100-01

As part of a C.O.R.E., multi-site longitudinal study comparing continuation electroconvulsive therapy (ECT) vs. continuation pharmacotherapy, the authors determined the response of 253 patients with major depression to acute-phase, bilateral ECT by use of the 24-item Hamilton Rating Scale for Depression. Remission rates for three age-groups, > or =65 years; 46-64 years; and < or =45 years, were 90 percent, 89.8 percent, and 70 percent, respectively. Age, as a continuous variable, positively influenced response to treatment. Bilateral, dose-titrated ECT is a highly effective acute treatment for major depression, and older age confers a greater likelihood of achieving remission.