Cognitive rehabilitation: assessment and treatment of persistent memory impairments following ECT

Abstract

Few tests address the types of memory problem commonly reported after electroconvulsive therapy (ECT). Here, we focus on the importance of neuropsychological assessment in ECT-treated patients and describe a number of tasks that may be useful in measuring the everyday memory problems of such patients with ongoing memory difficulties. At the time of writing, no attempts have been made to rehabilitate patients who experience persistent adverse cognitive effects, but clinicians should be aware of the potential beneficial role of cognitive rehabilitation in the treatment and management of these effects. In a recent issue of APT, Robertson & Pryor (2006) drew attention to a number of issues regarding the assessment of cognitive function in patients treated with electroconvulsive therapy (ECT

A Conceptual Introduction to Cognitive Remediation for Memory Deficits Associated With Right Unilateral Electroconvulsive Therapy

“…26,27 Importantly, the verbal working memory tasks we use have been associated with increased task-related activation in the left inferior frontal cortex, specifically the lateral orbital gyrus and increased dopaminergic D1 receptor activity in the cortex. 42 The strict information processing and sequencing tasks have shown to be associated with normalizing dorsal lateral prefrontal cortex metabolism, whereas the cognitive control training exercises are tied to inferior frontal gyrus activation.…”

“…The paper-and-pencil task is meant to prime the targeted memory skill, 35,42 isolate the acquiring mechanism, and prepare for the rehearsal of an identified memory processing pathway through drill and practice trials on the computer. Given the literature suggesting that intervention be applied as proximal to seizure episode as possible, 17,27 we conduct pre-ECT memory training sessions within 1 week of the first scheduled ECT treatment. Because treatment intensity may be important for enhancing effects, we have patients receive both pre-ECT training sessions on consecutive days and/or as close to the first ECT session as possible.…”

“…26 This is most pertinent, as the pattern of memory impairments associated with ECT is quite similar to the memory loss associated with temporal lobe epilepsy. 26,27 Electroconvulsive therapy patients do not seem to show deficits in priming, skill acquisition, or other types of procedural memory. The disturbance is one of consolidation and/or retrieval.…”

“…28 Although the lack of rigorous controlled studies using cognitive remediation in epilepsy makes efficacy determination inconclusive, the emerging literature on this topic provides some guidance in addressing memory problems in ECT. 27 The most pertinent factors, which seem to be associated with cognitive recovery in epilepsy and ECT, are (a) timely intervention preictally and postictally, with intervention applied as proximal to ictus as possible, (b) engaging the patient to achieve adequate treatment dosage of cognitive training preictally and postictally, (c) incorporating psychoeducation to inform the patient about effects of depression and ECT on memory, and (d ) precise memory training, which targets retrieval and consolidation deficits. 17,26,29 Our Memory Training for ECT (Mem-ECT) is designed to preserve cognitive functions, specifically anterograde and retrograde memory, which may be compromised after ECT.…”

Neuropsychiatric aspects of carbon monoxide poisoning: diagnosis and management

“…• components such as psychoeducation on the neuropsychiatric sequelae of CO poisoning, identification of behavioural deficits (Mangaoang 2007), reinforcing previously learned behaviour, establishing compensatory mechanisms for cognitive deficits (Bergquist 1997), and applying the strategies learnt to suit the patient's need through repeated practice;…”