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

Inclusion Criteria

1. Diagnosis of Dementia, of the following subtypes,

2. Alzheimer's dementia, according to NIA-AA Criteria for dementia

3. Vascular dementia based on: i. History consistent with insidious onset of illness and gradual clinical declineii. MRI evidence of microvascular ischemic disease (microinfarcts) iii. Physical andneurological examination do not indicate current or prior stroke c. Frontotemporaldementia d. Dementia with Lewy Bodies

4. Mini Mental Status Exam (MMSE) less than or equal to 15

5. Cohen-Mansfield Agitation Inventory Nursing Home Version (CMAI) score of 5 or moreon at least one item or score of 4 on two items of aggression or physicalnonaggression 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, or intentionalfalling (items 1-11, 14, 15) OR one score of 5 or more in items of verbal aggressionincluding screaming, making verbal sexual advances, and cursing or verbal aggression (items 22-24).

6. At least one failed pharmacological intervention to manage behavioral symptoms

7. Medically stable for safe administration of ECT verified by standard physicalexamination, urinalysis and serum chemistries and brain imaging when clinicallyindicated

8. Comprehension of English language

9. Authorized legal representative able and willing to give informed consent

10. Age 40 and above

Exclusion Criteria:

1. Current diagnosis of co-morbid delirium, measured by the Confusion AssessmentMeasure (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 andfunctional decline

• MRI scan within the past 12 months demonstrating evidence of hemorrhagic andembolic stroke

• Physical and neurologic examination consistent with current or prior stroke

3. Lifetime or current diagnosis of Schizophrenia, Bipolar Disorder or SchizoaffectiveDisorder

4. Active substance use disorder within past 6 months

5. Treatment with ECT or other neurostimulation therapies (e.g., TMS or vagal nervestimulation) within the past 3 months