Subjective and Objective Measures of Cognition in ECT: New Study From Denmark

 Out on PubMed, from investigators in Denmark, in JECT, is this study:

Cognitive Adverse Effects of Electroconvulsive Therapy: A Discrepancy Between Subjective and Objective Measures?

Hammershøj LG, Petersen JZ, Jensen HM, Jørgensen MB, Miskowiak KW.J ECT. 2021 Oct 13. doi: 10.1097/YCT.0000000000000797. Online ahead of print.PMID: 34699394
The abstract is copied below:

Objectives: The character and duration of cognitive adverse effects of electroconvulsive therapy (ECT) are unclear. This study investigated (1) the sensitivity of a short cognitive test battery to cognitive adverse effects of ECT, (2) the relation between subjective and objective cognitive adverse effects, and (3) patient characteristics associated with more subjective than objective adverse effects.

Methods: Forty-one patients with unipolar or bipolar depression referred to ECT underwent assessments at baseline, 5 to 7 days post-ECT, and 3 months post-ECT. Patients rated their fear of various aspects of ECT on a visual analog scale. At each assessment, patients were evaluated for depressive symptoms, completed the Screen for Cognitive Impairment in Psychiatry (SCIP) and Trail Making Test-Part B (TMT-B), and rated their cognitive difficulties.

Results: Patients feared cognitive adverse effects and lack of treatment efficacy more than other aspects of ECT. The SCIP and TMT-B revealed transient decline in objective cognition after ECT, which was reversed after 3 months. Patients presented with more subjective than objective cognitive difficulties at baseline and more subjective than objective cognitive adverse effects of ECT. This discrepancy was significantly reduced at follow-up. Younger age and poorer objective cognition pretreatment were associated with more subjective than objective cognitive adverse effects 5 to 7 days after ECT.

Conclusions: The SCIP and TMT-B are sensitive to cognitive adverse effects of ECT. Patients show more subjective than objective cognitive adverse effects of ECT. These insights can be used clinically to inform patients of treatment choice and expected cognitive consequences.







This is a wonderfully complex and interesting study. It introduces a novel short, but comprehensive neuropsychological test battery and makes us aware of the terms "cognitive stoicism," "cognitive sensitivity," and "cognitive discrepancy scores." It uses innovative statistical methods. The replication of the transitory nature of objective cognitive problems is reassuring; the increased understanding of subjective patient reports of cognitive problems is very helpful for clinicians. The lack of correlation between depression severity and subjective complaints is discrepant with some prior data; who knows if these new data are more convincing or an artifact of small sample size?
I recommend a full and careful read of this paper to all ECT personnel interested in cognitive effects of the treatment (~25 minutes), and then a second reading,(~ 15 minutes).

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