Is there any evidence in the literature for using ECT in dementia with combativeness (but not depressed) when behavioral interventions and medicines are not effective?

Please note that evidence for the use of ECT to treat dementia-associated agitation is very limited and currently only being done on an experimental basis

Agitation and aggression are very common and serious noncognitive symptoms in dementia and affect up to 80% of demented patients, impairing their quality of life and potentially endangering their caregivers. Noncognitive behavioral symptoms of dementia (NCBS) are a major precipitant of transfer to institutional care. Behavioral interventions and medications may provide alternatives for the treatment of NCBS, but their effectiveness may be limited. Furthermore, among the medications used to treat these symptoms, some such as the antipsychotics have been linked to medical complications including increased mortality and many are associated with undesirable effects such as sedation, increased confusion, and increased falls. ECT is an effective treatment for mania or depression in demented patients (1,2) and interest has been growing in ECT as a treatment for agitation even in patients with no history of mood disorder (3,4). Sutor and Rasmussen’s case series documents positive response in 3 of 4 patients with no mood disorder history (4). Our own prospective controlled trial, we hope, will be completed soon and add to the limited data currently available to guide treatment.


McDonald WM, Thompson TR. Treatment of mania in dementia with electroconvulsive therapy. Psychopharmacology Bull. 2001; 35(2):72-82

Roa V, Lyketsos CG. The benefits and risks of ECT for patients with primary dementia who also suffer from depression. Int J Geriatr Psychiatry 2000; 15:729-735

Grant JE, Mohan SN. Treatment of agitation and aggression in four demented patients using ECT. J ECT 2001; 17(3):205-209

Sutor B, Rasmussen KG. Electroconvulsive therapy for agitation in Alzheimer disease: A case series. J ECT 2008;24:239-41.