ECT in Lewy Body dementia: A case report

Dementia with Lewy Bodies (DLB) is the second most common cause of dementia after Alzheimers disease. Consensus guidelines for the clinical diagnosis of DLB specify a progressive disabling cognitive decline with the core features of fluctuating cognition, recurrent visual hallucinations, and spontaneous motor features of parkinsonism. Additional supporting features include neuroleptic sensitivity, delusions, rapid eye movement sleep, behavior disorder, and depressive symptoms. Neuropsychiatrie features of DLB such as hallucinations, delusions, apathy, and agitation are difficult to treat. Depression is a common comorbidity in DLB, with depressive symptoms reported in 33% to 50% of DLB cases. Little has been published on antidepressant treatment responses in DLB. Electroconvulsive therapy (ECT) is a safe and effective treatment for depression and other psychiatric illnesses that require a rapid response. ECT has been shown to be an effective treatment for depression in dementia, leading to improvements in both mood and cognition. In patients with parkinsonism, ECT can also sometimes transiently improve motor function. A literature search of MEDLINE and PsycINFO databases revealed no published literature describing the rise of ECT in DLB patients. We describe the case of a 60-year-old woman with DLB who experienced worsening depressive and neuropsychiatric symptoms who was treated with sertraline and citalopram without significant improvement. She received a course of 7 unilateral ECT sessions with an episode of autonomic instability after her first ECT session, but tolerated the remaining ECT sessions without incident. Her mood and neuropsychiatric symptoms improved for 2 weeks following ECT, but the benefits were not sustained. Further studies are needed to evaluate the potential role of ECT in the management of DLB.