Long Term Stable Cognitive Functioning after ECT- Data from The Low Countries

Neurocognitive functioning after electroconvulsive therapy in late-life depression: a four-year prospective study.

Obbels J, Vansteelandt K, Bouckaert F, Dols A, Stek M, Verwijk E, Sienaert P.Acta Psychiatr Scand. 2020 Nov 4. doi: 10.1111/acps.13252. Online ahead of print.PMID: 33150605
The abstract is copied below:

Objective: Despite the proven efficacy and safety of ECT, there is still concern about the possible cognitive side-effects of ECT in older patients. In this study we aimed to characterize the long-term cognitive effects of ECT in patients with late-life depression (LLD) from before the start until four years after the index ECT course.

Methods: 41 patients aged 55 years and older with a unipolar depression, referred for ECT were included. The neuropsychological test battery was assessed prior to ECT, 6 months, 1 year, 2 years, 3 years and 4 years after the last ECT session.

Results: We did not find any statistically significant cognitive changes from before the start to four years after ending the ECT-course. Although we could not detect cognitive changes at group level, we found clinically important differences on an individual level.

Conclusion: Cognitive performance in patients with LLD run a stable course from before the start of ECT until four years after the index course. At an individual level, however, both cognitive decline and improvement can be witnessed. Older patients can tolerate ECT and most of them will not experience long-term cognitive side-effects.

Keywords: ECT; cognition; depression; old age.

This is an excellent study with high quality data from our very productive colleagues in Belgium and The Netherlands. It is noteworthy for its long follow up period and comprehensive neurocognitive battery. The data are from the Mood Disorders in Elderly Treated with ECT (MODECT) study. About half of the sample had illness onset before age 55, about half after. About 75% of patients got mostly brief (not ultrabrief) RUL ECT, and about 25% got bilateral.
At an individual level, the great majority of patients showed no decrement in cognitive functioning at 4 years follow up; a  small, but approximately equal number, showed decline or improvement on individual cognitive tests. Limitations of the study include a small sample size by the end (18 patients at 4 years) and no measurement of autobiographical memory.
These data are highly reassuring; further research will likely help identify patients who are at risk for poorer-than-expected tolerability and help devise strategies to optimize their treatment.














Comments

Post a Comment

Popular posts from this blog

ECT vs Ketamine: NEJM Article Sets Up False Equivalency

Image
Out on PubMed, from investigators in the US, is this study: Ketamine versus  ECT   for Nonpsychotic Treatment-Resistant Major Depression. Anand A, Mathew SJ, Sanacora G, Murrough JW, Goes FS, Altinay M, Aloysi AS, Asghar-Ali AA, Barnett BS, Chang LC, Collins KA, Costi S, Iqbal S, Jha MK, Krishnan K, Malone DA, Nikayin S, Nissen SE, Ostroff RB, Reti IM, Wilkinson ST, Wolski K, Hu B. N Engl J Med. 2023 May 24. doi: 10.1056/NEJMoa2302399. Online ahead of print. PMID:  37224232 The abstract is copied below: Background:  Electroconvulsive therapy (ECT) and subanesthetic intravenous ketamine are both currently used for treatment-resistant major depression, but the comparative effectiveness of the two treatments remains uncertain. Methods:  We conducted an open-label, randomized, noninferiority trial involving patients referred to ECT clinics for treatment-resistant major depression . Patients with treatment-resistant major depression without psychosis were recruited and assigned in a 1:1 rat
Read more

RUL ECT vs Low Amplitude Seizure Therapy (LAP-ST)

Image
Out on PubMed, from the team in Augusta, Georgia, is this study: Double-Blinded Randomized Pilot Clinical Trial Comparing Cognitive Side Effects of Standard Ultra-Brief Right Unilateral ECT to 0.5 A Low Amplitude Seizure Therapy (LAP-ST). Youssef NA, McCall WV, Ravilla D, McCloud L, Rosenquist PB. Brain Sci. 2020 Dec 13;10(12):E979. doi: 10.3390/brainsci10120979. PMID:  33322138 The pdf is here . And from the Introduction : In theory, LAP-ST can be helpful because of the direct effect of lower electric current, but the principal reason is that LAP-ST has a more focal electric field (EF) [ 34 , 35 ]. The current amplitude is the primary factor that drives the EF into brain regions located deeper in the brain and is responsible for cognition and memory such as the hippocampus and temporal lobe [ 33 , 35 ]. This extra focality of the EF can minimize or avoid high EF stimulation to the deeper hippocampal and temporal lobe regions [ 33 , 35 ]. Minimization of deeper stimulation by using LAP
Read more

ECT For Children at a University Hospital: New Study in JECT

Image
 Out on PubMed, from authors at Vanderbilt and Mass General,, is this article: Use of   ECT   for Children With and Without Catatonia: A Single-Site Retrospective Analysis. Smith JR, Baldwin I, Termini KA, McGonigle T, Vandekar S, Luccarelli J. J ECT. 2024 Jan 25. doi: 10.1097/YCT.0000000000000993. Online ahead of print. PMID:  38265759 The abstract is copied below: Objectives: The objective study was to investigate the safety and efficacy of electroconvulsive therapy (ECT) in a retrospective cohort of pediatric patients. Methods: A single-site retrospective analysis was conducted of patients aged younger than 18 years who received ECT in a private university hospital from January 28, 2012 to April 8, 2023. Treatment efficacy and adverse events were determined retrospectively through review of the medical record. Results: A total of 36 pediatric patients met the inclusion criteria. Catatonia was the most common presenting indication for ECT, followed by psychosis and suicidal ideation.
Read more