Neurocognitive functioning after electroconvulsive therapy in late‐life depression: A 4‐year prospective study

Abstract

Objective Despite the proven efficacy and safety of ECT, there is still concern about the possible cognitive side effects of ECT in older patients. In this study, we aimed to characterize the long‐term cognitive effects of ECT in patients with late‐life depression (LLD) from before the start until 4 years after the index ECT course. Methods Fourty one patients aged 55 years and older with a unipolar depression, referred for ECT, were included. The neuropsychological test battery was assessed prior to ECT, 6 months, 1 year, 2 years, 3 years, and 4 years after the last ECT session. Results We did not find any statistically significant cognitive changes from before the start to 4 years after ending the ECT course. Although we could not detect cognitive changes at group level, we found clinically important differences on an individual level. Conclusion Cognitive performance in patients with LLD runs a stable course from before the start of ECT until 4 years after the index course. At an individual level, however, both cognitive decline and improvement can be witnessed. Older patients can tolerate ECT and most of them will not experience long‐term cognitive side effects.

Effectiveness of electroconvulsive therapy in patients lacking decision making capacity: A systematic review and meta-analysis

“…Previous studies have revealed that cognitive effects of ECT are mild and transient regardless of consent status [57]. Even in older patients, long-term follow-up does not reveal significant cognitive decline [58,59]. Additionally, ECT was well tolerated even in older patients with pre-existing cognitive impairment [60].…”

Ictal Theta Power as an Electroconvulsive Therapy Safety Biomarker

“…The therapeutic effect of ECT is achieved by administering a stimulus substantially above the seizure threshold, yet as the stimulus increases, it can worsen cognitive outcomes 1 . Although most ECT-associated cognitive adverse effects are acute and transient, some effects can persist for 6 months or longer 2–4 . These adverse effects include changes in attention, verbal fluency, memory, and executive function and can lead to suboptimal outcomes and worsening stigma toward the procedure 5,6 .…”

“…1 Although most ECTassociated cognitive adverse effects are acute and transient, some effects can persist for 6 months or longer. [2][3][4] These adverse effects include changes in attention, verbal fluency, memory, and executive function and can lead to suboptimal outcomes and worsening stigma toward the procedure. 5,6 Present day dosing algorithms, such as seizure threshold titration and formula dosing based on age and sex, lack scientific rationale as they are unable to account for individual variability to electric current (head shape, skull thickness, tissue composition, etc).…”

Biophysical mechanisms of electroconvulsive therapy-induced volume expansion in the medial temporal lobe: A longitudinal in vivo human imaging study

“…Electroconvulsive therapy (ECT) is an established effective treatment for severe depression, especially for older adults [ 1 – 4 ]. Although ECT induces multiple generalized seizures by the application of electric currents through the scalp under general anesthesia, ECT is a safe treatment with a low mortality rate [ 5 ], and is not associated with long-term cognitive decline in older patients [ 6 , 7 ] nor with increased risk of developing dementia [ 8 ], although some individuals experience cognitive side-effects [ 6 , 7 ].…”