Electroconvulsive Therapy Ameliorates Neuropsychiatric Symptoms in an Older Adult Patient With Nonshunted Normal Pressure Hydrocephalus

We report an 80-year-old male with nonshunted normal pressure hydrocephalus (NPH) presenting with an episode of recurrent major depressive disorder who underwent electroconvulsive therapy (ECT) with good effect and consequent amelioration of neuropsychiatric symptoms. NPH had been diagnosed several years prior, although a shunt was not pursued. On admission, it proved initially challenging to separate a mood disorder from behavioral and psychological symptoms of dementia (BPSD), as is the case for many patients with NPH. Following the diagnosis of recurrent major depressive disorder, the patient underwent 14 sessions of ECT. This resulted in a marked and sustained improvement in psychiatric symptoms. This case supports the putative safety of ECT for patients with nonshunted NPH and demonstrates the potentially long-term psychiatric benefit of ECT in this patient population.