Electroconvulsive Therapy Does Not Decrease Cognition Scores Among Those Who Have Impaired Cognition

Baseline cognition did not affect depression outcomes following electroconvulsive therapy (ECT) and the subset of patients with impaired global cognitive function did not exhibit poorer cognition after treatment. These findings were published in the American Journal of Geriatric Psychiatry.

This retrospective cohort study evaluated patient data from Massachusetts General Hospital. Patients (N=684) aged ≥50 years who received an acute course of ECT using a Mecta Spectrum 5000Q device between 2011 and 2019 were evaluated for cognition and depression outcomes on the basis of baseline cognitive function.

Patients were aged mean 61.7±7.8 years, 57.0% were women, 97.3% were White, 76.6% had major depressive disorder (MDD), 19.7% bipolar affective disorder (BAD), 45.3% had been psychiatrically hospitalized within 6 months, 54.2% were cognitively normal, 43.4% had mild cognitive impairment, and 2.3% moderate cognitive impairment.

After 10 ECT treatments, Montreal Cognitive Assessment (MoCA) scores remained unchanged (t_[683], -0.17; P =.86). Among the subset of patients with normal cognition (MoCA ≥26), the change in MoCA score decreased by 3.16 points (t_[683], -13.6; P <.001) relative to patients with impaired cognition, in which MoCA scores decreased among the normal cognition cohort (mean change, -1.44 points) and increased among the impaired cohort (mean change, 1.72 points).

There were no significant group differences in the change in depressive symptoms on the basis of cognition (P =.064).

Stratified by diagnosis, similar effects were observed among the patients with MDD and BAD (P =.086). Stratified by recent inpatient status, Quick Inventory of Depressive Symptomology (QIDS) scores were more significantly reduced for inpatients than patients who had not been hospitalized (t_[683], -3.4; P =.0001).

This study may have been limited by using MoCA as a measure of cognition, as this instrument cannot account for autobiographical memory loss which is a key domain that is affected by ECT.

The study authors concluded, “Among 684 geriatric patients receiving acute course ECT, the presence of baseline impaired global cognitive function was associated with cognitive improvement over the treatment course, while normal baseline cognition was associated with cognitive decline with treatment. Baseline cognitive status was not associated with a differential response in depression as measured by the QIDS.”

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Luccarelli J, Forester BP, Dooley M, et al. The effects of baseline impaired global cognitive function on the efficacy and cognitive effects of electroconvulsive therapy in geriatric patients: a retrospective cohort study. Am J Geriatr Psychiatry. 2021;S1064-7481(21)00561-3. doi:10.1016/j.jagp.2021.12.008

This article originally appeared on Psychiatry Advisor