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Detecting objective and subjective cognitive effects of electroconvulsive therapy: intensity, duration and test utility in a large clinical sample

  • G. Fernie (a1) (a2), D. M. Bennett (a1), J. Currie (a1), J. S. Perrin (a1) and I. C. Reid (a1)...

Abstract

Background

Electroconvulsive therapy (ECT) is an effective treatment for depression but the extent and persistence of cognitive side-effects remain uncertain. It has been reported that there is little evidence that impairments last longer than up to 15 days post-ECT. However, relatively few studies have followed patients for even as long as 1 month post-ECT. Here we report results from a brief cognitive battery given prior to ECT and repeated five times up to 6 months post-ECT.

Method

In a retrospective case-note study of routinely collected clinical data 126 patients treated with ECT completed two neuropsychological tests [Cambridge Neuropsychological Test Automated Battery (CANTAB) spatial recognition memory (SRM) and Mini Mental State Examination (MMSE)] and two subjective reports of memory function, prior to ECT. Patients were reassessed following ECT and at 1, 3 and 6 months post-ECT although not all patients completed all assessments.

Results

Performance relative to pre-ECT baseline was significantly poorer at each post-ECT assessment up to 3 months post-ECT using the CANTAB SRM, but was improved at 6 months. Conversely, MMSE score showed improvements relative to baseline from 1 month post-ECT. Mood and subjective memory scores improved following ECT and were correlated with one another, but not with either neuropsychological measure.

Conclusions

The CANTAB SRM task revealed reversible cognitive deficiencies relative to a pre-ECT baseline for at least 3 months following ECT, while MMSE score and patients' subjective reports showed only improvement. Visuospatial memory scores eventually exceeded baseline 6 months post-ECT.

Copyright

Corresponding author

* Address for correspondence: G. Fernie, Ph.D., Division of Applied Medicine (Psychiatry), School of Medicine and Dentistry, University of Aberdeen, Clinical Research Centre, Royal Cornhill Hospital Grounds, Aberdeen AB25 2ZH, UK. (Email: g.fernie@abdn.ac.uk)

References

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Berman, RM, Prudic, J, Brakemeier, E-L, Olfson, M, Sackeim, HA (2008). Subjective evaluation of the therapeutic and cognitive effects of electroconvulsive therapy. Brain Stimulation 1, 1626.
Brakemeier, E-L, Berman, R, Prudic, J, Zwillenberg, K, Sackeim, HA (2011). Self-evaluation of the cognitive effects of electroconvulsive therapy. Journal of ECT 27, 5966.
Calev, A, Nigal, D, Shapira, B, Tubi, N, Chazan, S, Ben-Yehuda, Y, Kugelmass, S, Lerer, B (1991). Early and long-term effects of electroconvulsive therapy and depression on memory and other cognitive functions. Journal of Nervous and Mental Disease 179, 526533.
Coleman, EA, Sackeim, HA, Prudic, J, Devanand, DP, McElhiney, MC, Moody, BJ (1996). Subjective memory complaints prior to and following electroconvulsive therapy. Biological Psychiatry 39, 346356.
Crawford, JR, Smith, G, Maylor, EA, Della Sala, S, Logie, RH (2003). The Prospective and Retrospective Memory Questionnaire (PRMQ): normative data and latent structure in a large non-clinical sample. Memory 11, 261275.
Dunne, RA, McLoughlin, DM (2012). Systematic review and meta-analysis of bifrontal electroconvulsive therapy versus bilateral and unilateral electroconvulsive therapy in depression. World Journal of Biological Psychiatry 13, 248258.
Falconer, DW, Cleland, J, Fielding, S, Reid, IC (2010). Using the Cambridge Neuropsychological Test Automated Battery (CANTAB) to assess the cognitive impact of electroconvulsive therapy on visual and visuospatial memory. Psychological Medicine 40, 10171025.
Folstein, MF, Folstein, SE, McHugh, PR (1975). ‘Mini mental state’. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189198.
Fraser, LM, O'Carroll, RE, Ebmeier, KP (2008). The effect of electroconvulsive therapy on autobiographical memory: a systematic review. Journal of ECT 24, 1017.
Howell, DC (2012) Treatment of Missing Data Part I (http://www.uvm.edu/~dhowell/StatPages/More_Stuff/Mixed-Models-Repeated/Mixed-Models-for-Repeated-Measures1.html). Accessed 4 October 2013.
Ingram, A, Saling, MM, Schweitzer, I (2008). Cognitive side effects of brief pulse electroconvulsive therapy: a review. Journal of ECT 24, 39.
McCall, WV, Dunn, A, Rosenquist, PB, Hughes, D (2002). Markedly suprathreshold right unilateral ECT versus minimally suprathreshold bilateral ECT: antidepressant and memory effects. Journal of ECT 18, 126129.
Ng, C, Schweitzer, I, Alexopoulos, P, Celi, E, Wong, L, Tuckwell, V, Sergejew, A, Tiller, J (2000). Efficacy and cognitive effects of right unilateral electroconvulsive therapy. Journal of ECT 16, 370379.
Owen, AM, Sahakian, BJ, Semple, J, Polkey, CE, Robbins, TW (1995). Visuo-spatial short-term recognition memory and learning after temporal lobe excisions, frontal lobe excisions or amygdalo-hippocampectomy in man. Neuropsychologia 33, 124.
Porter, R, Bourke, C, Gallagher, P (2007). Neuropsychological impairment in major depression: its nature, origin and clinical significance. Australian and New Zealand Journal of Psychiatry 41, 115128.
Prudic, J, Peyser, S, Sackeim, HA (2000). Subjective memory complaints: a review of patient self-assessment of memory after electroconvulsive therapy. Journal of ECT 16, 121132.
Robertson, H, Pryor, R (2006). Memory and cognitive effects of ECT: informing and assessing patients. Advances in Psychiatric Treatment 12, 228237.
Royal College of Psychiatrists (2005). The ECT Handbook, 2nd edn, Council Report CR128 (ed. Scott, A. I. F.). Royal College of Psychiatrists: London.
Sackeim, HA, Prudic, J, Devanand, DP, Kiersky, JE, Fitzsimons, L, Moody, BJ, McElhiney, MC, Coleman, EA, Settembrino, JM (1993). Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. New England Journal of Medicine 328, 839846.
Sackeim, HA, Prudic, J, Fuller, R, Keilp, J, Lavori, PW, Olfson, M (2007). The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology 32, 244254.
Scottish ECT Accreditation Network (SEAN) (2010). SEAN Standards. ISD Scotland Publications: Edinburgh.
Semkovska, M, McLoughlin, DM (2010). Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biological Psychiatry 68, 568577.
Sienaert, P, Vansteelandt, K, Demyttenaere, K, Peuskens, J (2010). Randomized comparison of ultra-brief bifrontal and unilateral electroconvulsive therapy for major depression: cognitive side-effects. Journal of Affective Disorders 122, 6067.
Smith, G, Della Sala, S, Logie, RH, Maylor, EA (2000). Prospective and retrospective memory in normal ageing and dementia: a questionnaire study. Memory 8, 311321.
Squire, LR, Wetzel, CD, Slater, PC (1979). Memory complaint after electroconvulsive therapy: assessment with a new self-rating instrument. Biological Psychiatry 14, 791801.
Tsaltas, E, Kalogerakou, S, Papakosta, V-M, Kontis, D, Theochari, E, Koutroumpi, M, Anyfandi, E, Michopoulos, I, Poulopoulou, C, Papadimitriou, G, Oulis, P (2011). Contrasting patterns of deficits in visuospatial memory and executive function in patients with major depression with and without ECT referral. Psychological Medicine 41, 983995.
UK ECT Review Group (2003). Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 361, 799808.

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