A Case of Lewy Body Dementia in Which Caffeine Loading Provided Effective Electroconvulsive Therapy

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The patient initially presented at age 86 with memory loss, hallucinations, and violent behavior, including physical aggression toward her husband. Two years prior to hospitalization, she had physical symptoms such as resting tremor and gait disturbance. Despite a diagnosis of unspecified cognitive decline and treatment with quetiapine (increased to 150 mg), her condition worsened, leading to admission to the psychiatric ward. Standard diagnostic procedures, including brain dopamine transporter scintigraphy, confirmed probable dementia with Lewy bodies (DLB). Her aggressive behavior, including physical assault on staff, continued. Traditional treatments, including increased doses of antipsychotics and electroconvulsive therapy (ECT), were initially ineffective. In particular, ECT failed to effectively induce seizures, a common challenge in elderly patients with DLB due to altered electrical activity in the brain. A breakthrough in treatment came with the preoperative administration of 500 mg of caffeine, which effectively eased seizures during ECT. Taken together, these findings indicate that while ECT may be effective at treating DLB symptoms, its efficacy is still uncertain. Thus, individualized approaches, such as preoperative caffeine administration, may be necessary.