Inflammation, White Matter Hyperintensities, Cognition and ECT: New Data From The Netherlands and Belgium

 Out on PubMed, from researchers in the Lowcountries, is this study:

Impact of Inflammation on Cognitive Functioning After Electroconvulsive Therapy in Older Patients with Depression with and Without White Matter Hyperintensities.

Carlier A, Dols A, Oudega M, Sienaert P, Bouckaert F, Stek ML, Eikelenboom P, van Exel E, Rhebergen D.Am J Geriatr Psychiatry. 2021 Sep 16:S1064-7481(21)00465-6. doi: 10.1016/j.jagp.2021.09.003. Online ahead of print.PMID: 34629222 

The abstract is copied below:

Objective: Should we treat older, patients with depression with white matter hyperintensities (WMH) with electroconvulsive therapy (ECT)? WMH, inflammation, depression and cognitive functioning are suggested to be intertwined. Hence, this study investigates whether the association between inflammation and cognition is different in patients with depression with or without WMH.

Methods: Cognitive functioning was assessed using the Mini-Mental State Examination during and after a course of ECT in 77 older patients with depression. Serum samples (C-reactive protein [CRP], interleukin-6 [IL-6], interleukin-10 [IL-10] and tumour necrosis factor-alpha [TNF-α]) and 3T magnetic resonance imaging were obtained prior to ECT.

Results: An interaction effect was found for IL-10, but not for CRP, IL-6 or TNF-α.

Conclusion: In general, the association between inflammatory markers and cognition in patients with depression treated with ECT is not different in patients with WMH compared to patients without WMH.

Keywords: Depression; cognition; cytokines; electroconvulsive therapy; hyperintensities; inflammation; white matter.






This is yet another careful study by our Lowcountry colleagues teasing out predictors of  ECT response and tolerability in geriatric depressed patients. These particular data are reassuring that white matter hyperintensities  (WMH) do not confer greater vulnerability to cognitive effects of ECT. The IL-10 and TNF-alpha association with decreased cognitive functioning only in the group with WMH adds incrementally to the understanding of the inflammation hypothesis of depression.
The authors correctly point out that a limitation of their study is having only the MMSE for cognitive assessment, a relatively gross measurement.
All followers of the the inflammation hypothesis of depression, the ECT cognition literature, and geriatric psychiatrists will want to read this paper in full, ~15 minutes. (An accompanying editorial will be the subject of a subsequent blog post).


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