Predictors of ECT Cognitive Effects: New Data From The Low Countries

Out on Pubmed, from investigators in The Netherlands and Belgium, is this study:

Pre-treatment predictors of cognitive side-effects after treatment with electroconvulsive therapy in patients with depression: A multicenter study.

Loef D, van Eijndhoven P, van den Munckhof E, Hoogendoorn A, Manten R, Spaans HP, Tendolkar I, Rutten B, Nuninga J, Somers M, van Dellen E, van Exel E, Schouws S, Dols A, Verwijk E.J Affect Disord. 2024 Jan 7:S0165-0327(24)00059-4. doi: 10.1016/j.jad.2024.01.049. Online ahead of print.PMID: 38195009

The abstract is copied below:

Background: Electroconvulsive therapy (ECT) is a highly effective treatment for major depressive episodes (MDE). However, ECT-induced cognitive side-effects remain a concern. Identification of pre-treatment predictors that contribute to these side-effects remain unclear. We examined cognitive performance and individual cognitive profiles over time (up to six months) following ECT and investigated possible pre-treatment clinical and demographic predictors of cognitive decline shortly after ECT.

Methods: 634 patients with MDE from five sites were included with recruitment periods between 2001 and 2020. Linear mixed models were used to examine how cognitive performance, assessed with an extensive neuropsychological test battery, evolved over time following ECT. Next, possible pre-treatment predictors of cognitive side-effects directly after ECT were examined using linear regression.

Results: Directly after ECT, only verbal fluency (animal and letter; p < 0.0001; Cohen's d: -0.25 and -0.29 respectively) and verbal recall (p < 0.0001; Cohen's d: -0.26) significantly declined. However, during three and six months of follow-up, cognitive performance across all domains significantly improved, even outperforming baseline levels. No other pre-treatment factor than a younger age predicted a larger deterioration in cognitive performance shortly after ECT.

Limitations: There was a substantial amount of missing data especially at 6 months follow-up.

Conclusions: Our findings show that verbal fluency and memory retention are temporarily affected immediately after ECT. Younger patients may be more susceptible to experiencing these acute cognitive side-effects, which seems to be mostly due to a more intact cognitive functioning prior to ECT. These findings could contribute to decision-making regarding treatment selection, psychoeducation, and guidance during an ECT course.

Keywords: Age; Cognitive side-effects; Depression; Electroconvulsive therapy; Predictors.

The paper is here.

And from the text:

This is a very interesting analysis of a large ECT cognitive dataset. The overall findings are consistent with the prior extensive literature showing transient, minor cognitive declines immediately after ECT, with a return to baseline, or better, shortly thereafter. The counterintuitive finding of increased cognitive effects in younger patients is a bit perplexing, and the authors' explanation of higher baseline cognitive functioning in this cohort is not fully explanatory.

Kudos to our Lowcountry colleagues for this very useful contribution to the cognition-in-ECT literature.