Electroconvulsive Therapy (ECT) for Agitation in Dementia (AD) (ECT-AD)

This is an interventional treatment trial for Alzheimer Dementia focused on measuring ECT, Agitation, Alzheimer's, Dementia Read More

Inclusion Criteria:

1. Diagnosis of Dementia, of the following subtypes,

   • Alzheimer's dementia, according to NIA-AA Criteria for dementia
   • Vascular dementia based on:
   • History consistent with insidious onset of illness and gradual clinical decline
   • MRI evidence of microvascular ischemic disease (microinfarcts)
   • Physical and neurological examination do not indicate current or prior stroke
   • Frontotemporal dementia
   • Dementia with Lewy Bodies
2. MMSE ≤ 15
3. Cohen-Mansfield Agitation Inventory Short Version (CMAI) score of ≥5 on at least one item of aggression or a physical nonaggressive item that holds potentially dangerous consequences including hitting (including self), kicking, grabbing onto people, pushing, throwing things, biting, scratching, spitting, hurting self or other, tearing things or destroying property, making physical sexual advances, trying to get to a different place, intentional falling, screaming, making verbal sexual advances, and cursing or verbal aggression (items 1-11, 14, 15, 22-24).
4. At least three failed pharmacological interventions from different drug classes (including antidepressants, antipsychotics, anticonvulsants, prazosin, and cannabinoids) at therapeutic doses (to be determined by clinical judgment) and duration of at least two weeks each to manage behavioral symptoms. These interventions may also include medications discontinued after 1 week due to tolerability concerns. Furthermore, medication trials that occur prior to admission to the hospital may count towards the three failed trials. The trials can be inpatient and/or outpatient. These trials can also be concurrent, such as using two medications from different classes for at least one week at the same time (i.e. polypharmacy).
5. Medically stable for safe administration of ECT verified by standard physical examination, urinalysis and serum chemistries
6. Comprehension of English language
7. Authorized legal representative able and willing to give informed consent
8. Age 55 - 89 years old (inclusive)

Exclusion Criteria:

1. Current diagnosis of co-morbid delirium, measured by the Confusion Assessment Measure (CAM) and by clinical diagnosis

2. Diagnosis of vascular dementia due to stroke, based on:

   • History consistent with abrupt onset and step-wise progression of cognitive and functional decline
   • MRI scan within the past 12 months demonstrating evidence of hemorrhagic and embolic stroke
   • Physical and neurologic examination consistent with current or prior stroke
3. Lifetime or current diagnosis of Schizophrenia, Bipolar Disorder or Schizoaffective Disorder
4. Active substance use disorder within past 6 months
5. Treatment with ECT or other neurostimulation therapies (e.g., TMS or vagal nerve stimulation) within the past 3 months