Age-related cognitive effects of ECT and ECT-induced mood improvement in depressive patients (original) (raw)
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Acta Psychiatrica Scandinavica, 2018
Long-term neurocognitive functioning after electroconvulsive therapy in patients with late-life depression. Objective: There is ongoing concern about the possible negative impact of ECT on neurocognitive functioning in older patients. In this study, we aimed to characterize the long-term cognitive effects of ECT in patients with late-life depression, using an extensive neuropsychological battery. Methods: A total of 110 patients aged 55 years and older with unipolar depression, referred for ECT were included. The neuropsychological test battery was assessed prior to ECT and 6 months after the last ECT session. Results: There were no statistically significant group-level changes from baseline to 6 months post-ECT in any of the neuropsychological measurements. Individual differences in cognitive performance were detected using the Reliable Change Index. Conclusion: Patients with late-life depression do not show deleterious cognitive effects 6 months following an ECT index course, although there are considerable differences at an individual level. Clinicians should not hesitate to prescribe ECT in older patients, as most of these patients will tolerate the treatment course and a small group will even experience a cognitive enhancement. However, clinicians should be aware that a small group of patients can experience cognitive sideeffects. Further study is needed to predict which patients have a higher risk of developing cognitive side-effects.
Cognitive side-effects of electroconvulsive therapy in elderly depressed patients
The Clinical neuropsychologist, 2014
Knowledge about cognitive side-effects induced by electroconvulsive therapy (ECT) in depressed elderly patients is sparse. In this study we investigated changes in the cognitive functioning of non-demented elderly depressed patients receiving ECT (n = 62) compared with healthy elderly people (n = 17). Neuropsychological tests were administered at the start of treatment and again within 1 week after treatment. We computed reliable change indices (RCIs) using simple regression methods. RCIs are statistical methods for analyzing change in individuals that have not yet been used in studies of the acute cognitive side-effects of ECT. At the group level, only letter fluency performance was found to be significantly reduced in the ECT group compared with the controls, whereas both groups demonstrated stable or improved performance on all other measures. At the individual level, however, 11% of patients showed retrograde amnesia for public facts post-ECT and 40% of the patients showed a sig...
Journal of Affective Disorders, 2015
Background: No prior study has investigated whether impairment of specific cognitive functions at baseline may predict the short-term treatment outcome of electroconvulsive therapy (ECT) in elderly non-demented patients with major depression (MD). Methods: This longitudinal cohort study included 65 elderly patients with unipolar or bipolar MD, aged 60-85 years, treated with formula-based ECT. Treatment outcome was assessed using the 17-item Hamilton Rating Scale for Depression (HRSD 17 ). Cognitive function at baseline was assessed using nine neuropsychological tests or subtests measuring information processing speed, verbal learning and memory, and aspects of executive function. Results: A poorer performance on the word reading task of the Color Word Interference Test rendered higher odds of achieving remission during the ECT course (p¼0.021). Remission was defined as an HRSD 17 score of 7 or less. There were no other significant associations between the treatment outcome of ECT and cognitive performance parameters assessed at baseline. Limitations: The limited number of subjects may have reduced the generalizability of the findings. Multiple statistical tests increase the risk for making a type I error.
The Clinical neuropsychologist, 2015
Electroconvulsive therapy (ECT) is an effective biological treatment option for severely depressed elderly patients; however, it can cause cognitive side effects, including anterograde and retrograde amnesia. Elderly patients with "cognitive impairment no dementia" (CIND) are reported as being more vulnerable to the cognitive side effects of ECT compared with patients with "no cognitive impairment" (NCI). The few studies that have reached this conclusion can be criticized for using insensitive outcome measures. The present study investigated cognitive side effects using standard neuropsychological tests before and after twice-weekly ECT. Patients were assessed at baseline (T1) and within one week after a course of ECT (consisting of a mean of 10 treatments) (T2), and were followed up for three months after T2 (T3). The sample included 54 patients with NCI (n = 36) or CIND (n = 18). For a control group, we recruited 17 healthy elderly persons. Tests of anterograde...
Journal of Affective Disorders, 2010
Background: Several variables have been studied as possible predictors for the efficacy of ECT, results from the few studies assessing the influence of age on the efficacy of ECT were inconsistent. In older patients suffering from severe depression, ECT is often the treatment of choice, therefore, investigating the influence of age on ECT response is considered relevant. Method: At two depression units, 141 patients meeting DSM-IV criteria for major depression and scores of at least 18 on the 17-item Hamilton Rating Scale for Depression (HAM-D) were treated with bilateral ECT, twice weekly. Clinical evaluation of depressive symptoms was performed each week; scores on the HAM-D were obtained 1-3 days prior to ECT and 1-3 days after termination of the ECT course. The primary outcome criterion was defined a priori as the mean change on the HAM-D score. The influence of age on mean change on the HAM-D score was analyzed with multiple linear regression analysis, adjusted for three covariables: center, duration of the index episode and presence of psychotic features. Results: Age as a continuous variable had no significant effect on the efficacy of ECT as measured by mean change on the HAM-D score (SE 0.057, p = 0.84). Limitations: The disproportionate distribution of patients among the three age groups appears to be the major limitation of the present study. Conclusion: This study suggests that the efficacy of ECT in elderly depressed patients is at least equal to that in younger depressed patients.
Pattern of cognitive dysfunction in depressive patients during maintenance electroconvulsive therapy
2003
Background. Objective data regarding adverse cognitive deficits associated with maintenance electroconvulsive therapy (M-ECT) are lacking. This study examined the cognitive state of depressive patients during M-ECT. Method. A cross-sectional study was carried out in 11 depressive patients in remission, all with a DSM-IV diagnosis of major depressive disorder. The mean number of previous ECT sessions was 36. 1, and the mean intersession interval was 52. 7 days. A group of 11 patients who had not received ECT was selected for comparison and matched for diagnosis, sex, age and years of schooling. All subjects were assessed using a complete neuropsychological battery including memory, attention and frontal function tests. Results. Groups did not present differences in long delay verbal recall. Encoding of new information and results on the frontal function tests were significantly lower in the M-ECT patients. Conclusion. Depressed patients preserve long-term memory, but suffer short-term memory impairment and frontal function alteration during M-ECT. Further longitudinal studies are necessary to determine the influence of M-ECT on non-memory functions and different memory subtypes.
A Prospective Study of Maintenance Electroconvulsive Therapy in an Elderly Depressed Population
Open Journal of Psychiatry, 2021
Objective: This study was conducted to discern the efficacy of maintenance electroconvulsive therapy (M-ECT) in a population of depressed elderly individuals with treatment-resistant depression. Methodology: Twenty-nine (N = 29) individuals over the age of 65 years of age and older were assigned to a control or treatment group on the basis of their decision to receive M-ECT (treatment group) or to refrain from receiving the treatment (control group). A battery of psychometric tests designed to measure severity of depression, quality of life, and cognition were administered at baseline as well as at 6-month and 1-year intervals. Results: Statistical analysis of the data indicated no significant differences in the efficacy of M-ECT between the control and treatment groups in any of the tests administered during the participation of the study. Conclusion: The results of the study suggest that there is no added benefit for patients administered M-ECT. However, study sample size and availability of alternative treatment regimens for the control group limit generalizability of these findings and warrant further investigation.
Fixed High-Dose Electroconvulsive Therapy in the Elderly With Depression
The Journal of ECT, 2006
Objective: To evaluate efficacy and tolerability of unilateral (RUL) and bilateral (BL) electroconvulsive therapy (ECT) in the elderly with depression. Methods: Thirty-nine elderly inpatients with major depression referred to ECT were randomized into RUL or BL ECT, using high, fixed electrical doses. Cognition and depression severity were assessed before, during, and 1 month after treatment. Adverse effects were assessed after each session. Results: Remission rates for RUL ECT (88.2%) and BL ECT (68.2%) were similar (P = 0.25). Reduction rates of depressive symptoms were also similar. There were no serious adverse events. There were more adverse effects in the BL ECT group (P = 0.05). BL ECT showed more short-term cognitive impairment, whereas improvements in neuropsychological scores were seen in both groups. Conclusion: In elderly depressive subjects, high-dose RUL ECT is as effective as BL ECT yet produces less adverse effects and less cognitive impairment.
2001
As part of a C.O.R.E., multi-site longitudinal study comparing continuation electroconvulsive therapy (ECT) vs. continuation pharmacotherapy, the authors determined the response of 253 patients with major depression to acute-phase, bilateral ECT by use of the 24-item Hamilton Rating Scale for Depression. Remission rates for three age-groups, Ն65 years; 46-64 years; and Յ45 years, were 90 percent, 89.8 percent, and 70 percent, respectively. Age, as a continuous variable, positively influenced response to treatment. Bilateral, dose-titrated ECT is a highly effective acute treatment for major depression, and older age confers a greater likelihood of achieving remission. (Am J Geriatr Psychiatry 2001; 9:382-390)