Hippocampal Volume Increase and Cognition in ECT: New Study in Translational Psychiatry

 Out on PubMed, from researchers at Hofstra/Northwell in New York, is this study:

ECT-induced cognitive side effects are associated with hippocampal enlargement.
Argyelan M, Lencz T, Kang S, Ali S, Masi PJ, Moyett E, Joanlanne A, Watson P, Sanghani S, Petrides G, Malhotra AK.Transl Psychiatry. 2021 Oct 8;11(1):516. doi: 10.1038/s41398-021-01641-y.PMID: 34625534

The abstract is copied below:
Electroconvulsive therapy (ECT) is of the most effective treatments available for treatment-resistant depression, yet it is underutilized in part due to its reputation of causing cognitive side effects in a significant number of patients. Despite intensive neuroimaging research on ECT in the past two decades, the underlying neurobiological correlates of cognitive side effects remain elusive. Because the primary ECT-related cognitive deficit is memory impairment, it has been suggested that the hippocampus may play a crucial role. In the current study, we investigated 29 subjects with longitudinal MRI and detailed neuropsychological testing in two independent cohorts (N = 15/14) to test if volume changes were associated with cognitive side effects. The two cohorts underwent somewhat different ECT study protocols reflected in electrode placements and the number of treatments. We used longitudinal freesurfer algorithms (6.0) to obtain a bias-free estimate of volume changes in the hippocampus and tested its relationship with neurocognitive score changes. As an exploratory analysis and to evaluate how specific the effects were to the hippocampus, we also calculated this relationship in 41 other areas. In addition, we also analyzed cognitive data from a group of healthy volunteers (N = 29) to assess practice effects. Our results supported the hypothesis that hippocampus enlargement was associated with worse cognitive outcomes, and this result was generalizable across two independent cohorts with different diagnoses, different electrode placements, and a different number of ECT sessions. We found, in both cohorts, that treatment robustly increased the volume size of the hippocampus (Cohort 1: t = 5.07, Cohort 2: t = 4.82; p < 0.001), and the volume increase correlated with the neurocognitive T-score change. (Cohort 1: r = -0.68, p = 0.005; Cohort 2: r = -0.58; p = 0.04). Overall, our research indicates that novel treatment methods serving to avoid hippocampal volume increase may result in a better side effect profile.

This is an interesting study with an intuitively attractive finding, namely that there is an association between hippocampal volume increase in ECT and cognitive effects. But the cohorts are very small and the results should really be considered preliminary or pilot data, IMO.
Since these authors are members of GEMRIC, they should be able to repeat a similar experiment in a much larger cohort of patients.  
For followers of the ECT neuroimaging literature, this paper is worth a full and careful read, ~15 minutes.

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