Stella Florindo, Radanovic Márcia, Gallucci-Neto José, Forlenza Orestes Vicente
Universidade de São Paulo, Faculdade de Medicina, Instituto de Psiquiatria, LIM-27, São Paulo SP, Brazil.
Universidade Estadual Paulista, Instituto de Biociências, Rio Claro SP, Brazil.
Dement Neuropsychol. 2023 Jul 24;17:e20230007. doi: 10.1590/1980-5764-DN-2023-0007. eCollection 2023.
Behavioral disturbances are clinically relevant in patients with dementia, and pharmacological regimens to mitigate these symptoms have provided limited results. Proven to be effective in several psychiatric conditions, electroconvulsive therapy is a potentially beneficial strategy for treating severe agitation due to dementia.
This review aimed to examine the publications on the efficacy, safety and tolerability of electroconvulsive therapy in treating patients with agitation due to dementia.
We performed a systematic analysis on the electroconvulsive therapy to treat patients with dementia and coexisting severe agitation. Articles were classified according to the level of evidence based on methodological design. Patients received an acute course of electroconvulsive therapy, often followed by maintenance intervention.
We selected 19 studies (156 patients; 64.1% women; 51-98 years old), which met the inclusion criteria: one case-control study by chart analysis (level of evidence 2); one open-label study (level of evidence 3); three historical/retrospective chart analyses (level of evidence 4); and 14 case series/reports (level of evidence 5). No randomized, sham-controlled clinical trials (level of evidence 1) were identified, which represents the main methodological weakness. Some patients had postictal delirium, cardiovascular decompensation and cognitive changes, lasting for a short time.
Overall, patients achieved significant improvement in agitation. However, the main finding of the present review was the absence of methodological design based on randomized and sham-controlled clinical trials. Despite methodological limitations and side effects requiring attention, electroconvulsive therapy was considered a safe and effective treatment of patients with severe agitation and related behavioral disorders due to dementia.
行为障碍在痴呆患者中具有临床相关性，而减轻这些症状的药物治疗方案效果有限。电休克治疗在多种精神疾病中已被证明有效，是治疗痴呆所致严重激越的一种潜在有益策略。
本综述旨在研究电休克治疗在治疗痴呆所致激越患者中的疗效、安全性和耐受性的相关文献。
我们对电休克治疗痴呆合并严重激越患者进行了系统分析。根据方法学设计将文章按照证据水平分类。患者接受一个急性电休克治疗疗程，通常随后进行维持干预。
我们选择了19项研究（156例患者；女性占64.1%；年龄51 - 98岁），这些研究符合纳入标准：1项通过图表分析的病例对照研究（证据水平2）；1项开放标签研究（证据水平3）；3项历史/回顾性图表分析（证据水平4）；以及14项病例系列/报告（证据水平5）。未发现随机、假对照临床试验（证据水平1），这是主要的方法学缺陷。一些患者出现了发作后谵妄、心血管失代偿和认知改变，持续时间较短。
总体而言，患者的激越症状有显著改善。然而，本综述的主要发现是缺乏基于随机和假对照临床试验的方法学设计。尽管存在方法学局限性和需要关注的副作用，但电休克治疗被认为是治疗痴呆所致严重激越及相关行为障碍患者的一种安全有效的方法。
