Electroconvulsive therapy for dementia with Lewy bodies: A systematic review and Japanese multicenter survey

Abstract

Management of psychiatric symptoms in dementia with Lewy bodies (DLB) is challenging due to hypersensitivity to psychotropic medications. Electroconvulsive therapy (ECT) is a potential therapeutic option for DLB, but its efficacy and safety remain uncertain. We systematically reviewed articles on ECT for DLB, including those published in Japanese-language journals, and surveyed institutions certified by the Japanese Psychogeriatric Society. Of 41 peer-reviewed articles, 32 were from Japan. The proportion of prodromal DLB cases was significantly higher in Japan (34.8 %) than in other countries (9.5 %) (p = 0.044). Cardiac [123I]-metaiodobenzylguanidine scintigraphy and/or striatal dopamine transporter imaging were significantly more frequently in Japan (71.8 %) than in other countries (5.5 %) (p < 0.001). ECT has shown effectiveness in treating depression, catatonia, agitation and psychosis. It was generally considered safe, with transient delirium being the most common side effect, occurring in 16.1 % of Japanese cases. However, current evidence is limited to case studies and lacks randomized controlled trials. The survey confirmed that ECT is widely performed for DLB in Japan, although the number of cases treated varied greatly across institutions. These findings underscore the need for standardized ECT guidelines for DLB. Multicenter studies with standardized assessments and longitudinal follow-up are essential to further research on ECT for DLB, including psychiatric-onset prodromal DLB.