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.














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