Baseline Cognition and ECT Outcome: New Study From McLean Hospital

Out on PubMed, from researchers at McLean Hospital, is this paper:

First Acute-Course Electroconvulsive Therapy for Moderate-to-Severe Depression Benefits Patients With or Without Accompanying Baseline Cognitive Impairment.

Copersino ML, Long MP, Bolton P, Ressler KJ, Seiner SJ, Yip AG.J ECT. 2021 Dec 28. doi: 10.1097/YCT.0000000000000819. Online ahead of print.PMID: 34966040

The abstract is copied below:

Background: Researchers are increasingly investigating therapeutic response associated with new patient subgroups as a way to improve electroconvulsive therapy (ECT) treatment outcomes and reduce adverse events. This study is the first to examine baseline cognitive impairment status as a predictor of clinical outcome in first acute-course ECT patients.

Methods: Baseline cognitive function at various thresholds and serial depressive symptom severity data from first-time ECT patients were examined using generalized linear mixed-effects models.

Results: Of 1345 patients who met the inclusion criteria, 617 had available data at their third assessment visit (~15th treatment visit). There was a robust improvement in depression symptoms over time (P < 0.0001), and cognitive function was not associated with baseline levels of depressive symptoms or serially measured change in self-reported symptom severity during acute-phase ECT.

Conclusions: These results indicate that an acute course of ECT for the treatment of moderate-to-severe depression benefits patients with or without accompanying baseline cognitive impairment. These findings may be useful in informing shared decision-making discussions about ECT risks and expected benefits.

And from the text:

This study examined the clinical utility of baseline cognitive function in predicting treatment outcomes in moderately-to severely depressed patients without an ECT history undergoing a 15-treatment course of ECT. Results of this study indicate that baseline cognitive function as measured by the MoCA is not associated with either baseline depressive symptom severity or serially measured change in total QIDS-SR score during acute-phase ECT. Although cognitive impairment trended toward more favorable mood outcomes (particularly at assessment visit 3 based on a MoCA cutoff score of 26), it did not reach statistical significance.

In conclusion, given the increasingly common use of the MoCA in ECT patient settings, it is important to know if its clinical utility extends to the identification of a patient subgroup with a greater likelihood of positive response to first acute-course ECT. Although there is some evidence that cognitive impairment in major depressive disorder is predictive of poorer pharmacological treatment response, results from our large cohort indicate that an acute course of ECT for the treatment of moderate-to-severe depression benefits patients with or without accompanying baseline cognitive impairment. In combination with other study findings, the present study contributes further to our understanding of expected ECT risks and benefits and may be useful in informing shared decision making discussions between clinicians and their patients and families who may fear the presence of cognitive impairment could limit the therapeutic benefits or increase cognitive risks of ECT.

This paper is yet another product of the vast clinical ECT database in the Harvard system. The conclusions, despite the limitations of the retrospective study design and assessment instruments, are useful, if not surprising.

This study is very similar to the recently published study by Luccarelli et al. in AJGP showing improvement in cognition after ECT in patients with baseline impaired cognition.

A full read of this paper in JECT will be ~20 minutes, recommended.