認知症における攻撃性と興奮のための電気療法:探索的なメタ分析と倫理的視点による体系的レビュー
Sarah Kayser1, Andreas Fallgatter1, Florian Funer2
1Department of Psychiatry and Psychotherapy (SK, AF), University of Tuebingen, Tuebingen, Baden-Württemberg, Germany; German Center for Mental Health (SK, AF), University of Tuebingen, Tuebingen Site, Tuebingen, Germany.
まとめ
電気ショック療法 (ECT) は,認知症における攻撃性と興奮に対する安全で効果的な最後の手段の治療法であり,ほとんどの患者で数週間以内に顕著な改善を示しています. このセラピーは,他の方法が失敗したとき,行動症状に迅速な救済を提供します.
科学分野:
- 高齢者精神科医の精神医学について
- 神経科学は神経科学である.
- クリニカル・セラピエティクス
背景:
- 攻撃性と興奮を含む認知症 (BPSD) の行動的および心理的な症状は,治療が困難であり,通常は従来の治療法に耐性があります.
- BPSDの既存の治療法は,弱い高齢者のために重大なリスクを負っており,代替介入の探求が必要である.
研究 の 目的:
- 認知症患者における攻撃性および興奮性の管理において,電気ショック療法 (ECT) の臨床的証拠を体系的に検討する.
- 耐火性BPSDの治療としてECTの有効性,安全性,耐受性を評価する.
主な方法:
- PRISMAのガイドラインに従って,関連する臨床試験の主要なデータベース (PubMed,EMBASE,Cochrane Library) を検索して,体系的なレビューが行われました.
- 対象となった研究には,症例報告,シリーズ,観察コホート,チャートレビュー,ランダム化試験プロトコルなどがあり,患者の特徴,ECTパラメータ,アウトカム,有害事象に関するデータを分析した.
- 探索的なランダム効果メタアナリシスが実施され,臨床応答率をまとめました.
主要な成果:
- 206人の患者を対象とした13件の研究では,入場基準を満たし,ほとんどの患者は臨床的に重要な改善を示しました.
- プール分析では,臨床応答比率は77.7% (95%CI 71.0%-83.3%) であり,通常は2~4回の治療で改善が観察された.
- ECTは一般的によく耐えており,軽度で一時的な副作用があり,治療に関連した死亡または重篤な合併症は報告されていません.
結論:
- 電気ショック療法 (ECT) は,認知症における耐性攻撃性および興奮性に対する迅速で効果的な,比較的安全な選択肢であるようです.
- ECTは,他の治療法が効果的でないか,または禁忌である場合,重度のBPSDに対する貴重な最後の手段として役立つ可能性があります.
- これらの発見を確認し,臨床実践を導くために,さらに高品質で,将来性があり,倫理的に健全なコントロールされた研究は正当化されています.
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