Rijnmond Care Group, Location Nursing Home Slingedael, Centre for Korsakoff and Psychogeriatry, Rotterdam, The Netherlands.
J ECT. 2012 Mar;28(1):34-8. doi: 10.1097/YCT.0b013e31823a0f5a.
Depression is one of the most frequently diagnosed psychiatric disorders in patients with dementia with a prevalence of up to 50%. The detrimental effects of depression in dementia include disability in daily living, worse quality of life, and faster cognitive decline. Although electroconvulsive therapy (ECT) is a well-established and effective treatment for depression in the elderly, it is currently an overlooked treatment option in the elderly with dementia and depression. The aim of this review was to provide a critical analysis of the efficacy and safety of ECT in depression superimposed on dementia by reviewing the current literature on this topic. Current evidence suggests that ECT is an effective treatment for depression in dementia, although the relatively small number of controlled studies hampers the comparison of effectiveness between healthy nongeriatric patients and those with dementia. Moreover, the systematic reports on cognitive side effects are very limited in number and currently only apply to moderately mild or mild dementia of nonvascular origin. Some studies do suggest that cognitive side effects are likely in later stages of dementia and in patients with vascular dementia. It is therefore of crucial relevance to prospectively study effects of ECT in different types and phases of dementia in controlled trials. From a clinical perspective, it is essential to inform and educate patients and family about the possible risks and benefits of ECT treatment for depression in dementia.
抑郁症是痴呆患者中最常见的精神疾病之一，患病率高达 50%。抑郁症在痴呆症中的不良影响包括日常生活能力障碍、生活质量更差和认知衰退更快。尽管电休克疗法 (ECT) 是治疗老年人抑郁症的一种成熟且有效的方法，但目前它在老年痴呆症伴抑郁症患者中是一种被忽视的治疗选择。本综述的目的是通过回顾该主题的现有文献，对 ECT 在痴呆症并发抑郁症中的疗效和安全性进行批判性分析。目前的证据表明，ECT 是治疗痴呆症并发抑郁症的有效方法，尽管相对较少的对照研究限制了将其与健康非老年患者的有效性进行比较。此外，关于认知副作用的系统报告数量非常有限，目前仅适用于非血管性轻度或中度痴呆。一些研究确实表明，认知副作用可能发生在痴呆症的晚期和血管性痴呆症患者中。因此，在对照试验中前瞻性地研究 ECT 在不同类型和阶段的痴呆症中的作用至关重要。从临床角度来看，必须告知和教育患者及其家属关于 ECT 治疗痴呆症并发抑郁症的可能风险和益处。
