New Meta-Analysis of Cognitive Effects
Out on PubMed, from researchers in Quebec, Canada, is this meta-analysis:
J ECT. 2020 Oct 1. doi: 10.1097/YCT.0000000000000723. Online ahead of print.PMID: 33009218
The abstract is copied below:
Electroconvulsive therapy (ECT) remains one of the most effective treatments for major depressive disorder, but uncertainties persist regarding the cognitive tests to include in ECT follow-up. The current study is a systematic review and meta-analysis of the most frequent cognitive side effects after ECT. We also discuss the most common cognitive tests in ECT follow-up. We searched studies published from 2000 to 2017 in English and French language in Pubmed, EBM Reviews, EMBASE, and PsycINFO. Standardized cognitive tests were separated into 11 cognitive domains. Comparisons between cognitive measures included pre-ECT baseline with post-ECT measures at 3 times: PO1, immediately post-ECT (within 24 hours after last ECT); PO2, short term (1-28 days); and PO3, long term (more than 1 month). A total of 91 studies were included, with an aggregated sample of 3762 individuals. We found no significant changes in global cognition with Mini-Mental State Examination at PO1. Hedges g revealed small to medium effect sizes at PO2, with individuals presenting a decrease in autobiographical memory, verbal fluency, and verbal memory. Verbal fluency problems showed an inverse correlation with age, with younger adults showing greater deficits. At PO3, there is an improvement on almost all cognitive domains, including verbal fluency and verbal memory. There is a lack of standardization in the choice of cognitive tests and optimal cognitive timing. The Mini-Mental State Examination is the most common screening test used in ECT, but its clinical utility is extremely limited to track post-ECT cognitive changes. Cognitive assessment for ECT purposes should include autobiographical memory, verbal fluency, and verbal memory.And from the text:
This is yet another magnum opus that required enormous effort to compile. It is meant as an update to the Semkovska and McLoughlin meta-analysis of 2010 (Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Semkovska M, McLoughlin DM. Biol Psychiatry. 2010 Sep 15;68(6):568-77), and includes diagnoses other than depression.
The overall conclusions are encouraging and not surprising; that the adverse cognitive effects of ECT are largely transient, and that pre-ECT cognitive deficits are often reversed at long term follow up.
Meta-analyses are only as good as the data they input, and these authors are circumspect about the limitations of their findings. I noted they included the word "innocuity"as one of their search terms. Is that even a word?
The finding of more short term verbal fluency impairment in younger patients seems counterintuitive. The finding that studying autobiographical memory is difficult is very intuitive.
The below comment is from Max Fink:
ReplyDeleteMemory tests OOBS for Surgery October 15, 2020
I wonder how surgeons would react to psychologists and other bean counters arguing that a measure of treatment efficacy and risk was "Ounces of Blood Spilled" (OOBS) during a procedure? After all, blood is precious. Picture a "blood spilled rating scale" that becomes part of every surgical report.
Post ECT cognitive rating scales are useless measures that tickle psychologists and the Reads and Breggins who argue daily that ECT is an unproven technology.
Memory tests were part of my assessments of electrode placements with Robert Kahn in 1957, with Richard Abrams and Jan Volavka in 1973, and with Charles Kellner and the CORE team in 2004. Every study showed temporary errors for up to 3 months, and then improved cognition tests with recovery. Like blood loss in surgery, made up during recovery, memory functions return to baselines with recovery.
80 years of denigration of ECT and obeisance to psychology is enough! Measure EEG seizure duration! Measure prolactin! Measure HAMD and BFCRS! These indices are useful measures of the efficacy of the seizure.
Max Fink