Transient Cognitive Impairment and White Matter Hyperintensities in Severely Depressed Older Patients Treated With Electroconvulsive Therapy

BACKGROUND: Although electroconvulsive therapy (ECT) is a safe and effective treatment for patients with severe late life depression (LLD), transient cognitive impairment can be a reason to discontinue the treatment. The aim of the current study was to evaluate the association between structural brain characteristics and general cognitive function during and after ECT. METHODS: A total of 80 patients with LLD from the prospective naturalistic follow-up Mood Disorders in Elderly treated with Electroconvulsive Therapy study were examined. Magnetic resonance imaging scans were acquired before ECT. Overall brain morphology (white and grey matter) was evaluated using visual rating scales. Cognitive functioning before, during, and after ECT was measured using the Mini Mental State Examination (MMSE). A linear mixed-model analysis was performed to analyze the association between structural brain alterations and cognitive functioning over time. RESULTS: Patients with moderate to severe white matter hyperintensities (WMH) showed significantly lower MMSE scores than patients without severe WMH (F(1,75.54) = 5.42, p = 0.02) before, during, and post-ECT, however their trajectory of cognitive functioning was similar as no time × WMH interaction effect was observed (F(4,65.85) = 1.9, p = 0.25). Transient cognitive impairment was not associated with medial temporal or global cortical atrophy (MTA, GCA). CONCLUSION: All patients showed a significant drop in cognitive functioning during ECT, which however recovered above baseline levels post-ECT and remained stable until at least 6 months post-ECT, independently of severity of WMH, GCA, or MTA. Therefore, clinicians should not be reluctant to start or continue ECT in patients with severe structural brain alterations

"Cognitive trajectories during and after electroconvulsive therapy in patients with MDE: Taking different perspectives" (vol152, pg 132, 2022)

Stress-related psychiatric disorders across the life spa

Dokter, komt mijn geheugen terug? Elektroconvulsietherapie en cognitieve bijwerkingen in de praktijk

ACHTERGROND Patiënten die behandeld (gaan) worden met elektroconvulsietherapie (ECT) zijn vaak bang voor cognitieve bijwerkingen. DOEL Beantwoorden van vragen die patiënten en verwijzende behandelaars vaak stellen over cognitieve problemen bij ECT. METHODE Bespreken van cognitieve problemen bij ECT op basis van klinische waarnemingen en literatuur. RESULTATEN De cognitieve problemen die ect veroorzaakt, zijn kortdurende postictale verwardheid (kort na de behandeling), anterograde en retrograde amnesie. Bij anterograde amnesie is de patiënt tot drie maanden na de behandeling tijdelijk minder goed in staat om informatie over nieuwe gebeurtenissen op te slaan. Retrograde amnesie betreft het onvermogen om informatie of procedures die voor aanvang van de ect-behandelserie opgeslagen zijn, op te diepen uit het geheugen. Het gaat daarbij om semantische geheugenproblemen (feitenkennis), episodische geheugenproblemen (niet meer kunnen opdiepen van herinneringen aan (on)persoonlijke gebeurtenissen) en procedurele geheugenproblemen (niet meer weten hoe apparaten bediend moeten worden). Het is lastig te voorspellen welke patiënten last krijgen van cognitieve problemen bij ect en in welke mate. Onderhoudsbehandeling verergert de problemen niet. Van ect-geïnduceerde retrograde amnesie lijken vooral feitelijke en autobiografische geheugenproblemen een meer blijvend karakter te hebben. Volgens de Nederlandse richtlijn voor ect moeten cognitieve bijwerkingen gemonitord worden. Door voor en na ect te monitoren, kan men de patiënt gerichter psycho-educatie bieden en eventueel gericht indicatie stellen voor een training. CONCLUSIE Wij concluderen dat ECT-gerelateerde cognitieve bijwerkingen een belangrijk aandachtspunt zijn in de praktijk. Er is sprake van interindividuele variabiliteit en cognitieve monitoring wordt aanbevolen om het beloop te volgen en te evalueren

ECT-Related Anxiety: A Systematic Review

Background: A significant proportion of electroconvulsive therapy (ECT)-treated patients experience anxiety anticipating the treatment, often to such an extent that they refuse or discontinue a much-needed treatment. Despite its great impact on treatment adherence, anxiety in patients receiving ECT is underexposed in the scientific literature. Objectives: We aimed to review the prevalence and specific subjects of ECT-related anxiety and therapeutic interventions to reduce it. Methods : We performed a computerized search (EMBASE, MEDLINE, and PsycINFO) for articles meeting the following inclusion criteria: (1) qualitative (interview) studies, quantitative (questionnaire) studies, or experimental (interventional) studies that (2) report on anxiety that is related to a planned, ongoing, or past ECT treatment. Results: Of 1160 search results, 31 articles were included. Electroconvulsive therapy-related anxiety is estimated to be present in 14% to 75% of patients and is most often linked to worries about memory impairment or brain damage. Only a few interventions (chlorpromazine, meprobamate, propofol, a talking-through technique, an information leaflet, and animal-assisted therapy) have been proposed to reduce patients' ECT-related anxiety. Conclusions: Electroconvulsive therapy-related anxiety is a highly prevalent phenomenon, and the literature provides little guidance for its clinical management. Most studies are of a low methodological quality and suffer from significant limitations, thereby hampering generalized conclusions. Given the clinical importance of ECT-related anxiety, further study on its nature and evolution through the course of treatment and on anxiety-reducing interventions is warranted

Dokter, komt mijn geheugen terug? Elektroconvulsietherapie en cognitieve bijwerkingen in de praktijk

BACKGROUND Patients undergoing or about to undergo electroconvulsive therapy (ECT) are often afraid they will experience negative cognitive side-effects. AIM To answer questions that patients and referring clinicians often ask about cognitive problems that can result from ECT. METHOD Todiscuss.on the basis of clinical perception and literature, the cognitive problems resulting from ECT. RESULTS The cognitive problems resulting from ECT are threefold: short-term postictal confusion (immediately after the treatment), anterograde amnesia and retrograde amnesia. A patient affected by anterograde amnesia, is temporarily less able to remember what he or she has experienced over a period of three months after treatment. The brain of a patient with retrograde amnesia is unable to retrieve or remember information or procedures 'saved' before the treatment took place. More specifically the patient with retrograde amnesia has three main types of problems: semantic memory problems (relating to facts), episodic memory problems (no longer able to retrieve memories concerning non-personal events), and procedural memory problems (no longer able to operate various devices). It is difficult to predict which patients will experience cognitive problems as a result from ECT and to what extent. However, the problems are not intensified by maintenance treatment. Factual and autobiographical memory problems following ECT-induced retrograde amnesia seems to have a more permanent character.Accordingtothe Dutch guidelines for ECT, cognitive side-effects need to be monitored. If patients are monitored before and after ECT, they can be given a more targeted psycho-education and eventually a more targeted training course. CONCLUSION We conclude that in clinical practice increasing attention is being given to ECT-related cognitive side-effects. Clearly, however, more consideration needs to be given to inter-individual variability. Cognitive monitoring is advisable because the course of the side-effects of ECT must be followed and evaluated

Monitoring ECT-related anxiety: the ECT-related Anxiety questionnaire (ERAQ)

Introduction:Although electroconvulsive therapy (ECT) is an effective and safe treatment, a significant proportion of patients are afraid of the treatment. Too often, this ECT-related anxiety makes patients refuse or discontinue ECT. A reliable questionnaire designed to measure ECT-related anxiety is currently not available. We report the development and psychometric evaluation of the ECT-related anxiety questionnaire (ERAQ), a questionnaire that measures anxiety with respect to ECT in clinical practice. Methods: This study was conducted at two psychiatric hospitals in Belgium and The Netherlands. Patients who were about to start with or were having an ECT course were included. ECT-related anxiety was measured with a Dutch self-designed questionnaire. The questionnaire contains 17 items further subdivided into a five-point scale. We used an exploratory (EFA) and confirmatory factor analysis (EFA) to investigatepsychometric properties of the ERAQ. We also examined the ERAQ in the context of item response theory (IRT). Results: 185 patients were included. From the EFA we concluded that the scale was unidimensional. The location parameters for the 17 parameters reflected a sizeable underlying anxiety for ECT (-1.06; 2.02). Conclusion: ERAQ is a valid questionnaire to measure ECT-related anxiety. ERAQ offers a global score in the form of the sum of 17 items on a 4-category response scale as a measure of severity of ECT-related anxiety. Moreover, the ERAQ can differentiate between various topics of anxiety and can inform the clinician about the specific aspects of an ECT-course that trigger less or more anxiety. The differentiation of the ERAQ between various topics and intensities of anxiety can have an important role in the future development of psychoeducational programs and in guiding clinicians to talk with their patients and relatives about ECT-related anxieties