The benefits and risks of ECT for patients with primary dementia who also suffer from depression

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 electroconvulsive treatment (ECT). However, the use of ECT in dementia patients is concerning due to possibble 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 with a 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 mood is achieved. Copyright (C) 2000 John Wiley and Sons, Ltd.