TY - JOUR
T1 - Pre-treatment predictors of cognitive side-effects after treatment with electroconvulsive therapy in patients with depression
T2 - A multicenter study
AU - Loef, Dore
AU - van Eijndhoven, Philip
AU - van den Munckhof, Eva
AU - Hoogendoorn, Adriaan
AU - Manten, Ruby
AU - Spaans, Harm-Pieter
AU - Tendolkar, Indira
AU - Rutten, Bart
AU - Nuninga, Jasper
AU - Somers, Metten
AU - van Dellen, Edwin
AU - van Exel, Eric
AU - Schouws, Sigfried
AU - Dols, Annemiek
AU - Verwijk, Esmée
PY - 2024/3/15
Y1 - 2024/3/15
N2 - 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.
AB - 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.
KW - Age
KW - Cognitive side-effects
KW - Depression
KW - Electroconvulsive therapy
KW - Predictors
U2 - 10.1016/j.jad.2024.01.049
DO - 10.1016/j.jad.2024.01.049
M3 - Article
SN - 0165-0327
VL - 349
SP - 321
EP - 331
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
ER -