Systematic Review of Cognitive Effects of Electroconvulsive Therapy in Late-Life Depression
Introduction
Late-life depression (LLD) is a serious public health problem with an estimated prevalence of 1.8%–13.3% in the community and 20%–25% in long-term care settings.1, 2, 3 The relationship between LLD and cognition is complex. LLD is known to present as a prodrome of dementia and is also known to negatively impact cognition, thus considered as one of the main modifiable risk factors for dementia.4, 5, 6, 7 In one study 45% of patients with LLD were found to be cognitively impaired at a 1-year follow-up, even after remission of mood symptoms.5 Long-term antidepressant medications do not improve cognition, despite maintenance of recovery from depressive symptoms.8, 9 Thus, there is a need to understand interventions that impact cognition in patients with LLD.
Neurostimulation interventions have been associated with positive and negative impact on cognition. Electroconvulsive therapy (ECT) is a well-established treatment for LLD, with remission rates around 60% and response rates of up to 90%.10, 11, 12 However, ECT can impair cognition.13, 14, 15 Studies in adults with depression have shown that ECT causes both anterograde and retrograde memory deficits.10, 14, 16, 17 In contrast, studies using novel electrical and magnetic brain stimulation interventions have shown a pro-cognitive effect, for example, of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) among patients with neuropsychiatric disorders.18, 19, 20, 21, 22, 23, 24 However, little is known about the effects of these interventions on cognition in patients with LLD. Thus, the objective of this review is to systematically assess the effects of ECT on cognition in LLD. We also covered in our search other brain stimulation interventions.
Section snippets
Search Strategy
EMBASE, Ovid Medline, and PsycINFO were searched in June 2015 using the following terms: (electroconvulsive therapy or transcranial magnetic stimulation or transcranial direct current simulation or vagus nerve stimulation or deep brain stimulation or rTMS or magnetic seizure therapy) AND depress* AND cognit*. The search was limited to “age 65 and over,” “human,” “English,” and “peer-reviewed journal.” Publications reporting mean age above 65 years or analyzed greater than 65 years age group as
Publications Reporting Only Short-Term Effects of ECT
Six publications reported only short-term effects of ECT on cognition in LLD as a primary outcome.26, 27, 28, 29, 30, 31 The first publication (Table 1, serial 1) reported on62 patients (mean age: 74.7; standard deviation [SD]: 6.6; mean number of ECT sessions: 9.5; SD: 3.2). There was a decline in performance on letter fluency as measured by the FAS test (Controlled Oral Word Association Test using letters F, A and S) from the Delis-Kaplan Executive Function System battery. There was no
Discussion
To date, ECT remains the most effective brain stimulation for treating mood symptoms in patients with LLD, but it has been associated with cognitive deficits. These cognitive deficits have been better characterized in the general adult population than in geriatric groups.11, 17 The current literature is striking in that it does not provide convincing evidence that ECT is associated with clinically significant cognitive deficits in LLD except for a transient cognitive impairment during the acute
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Cited by (51)
Electroconvulsive therapy for catatonia in anti-NMDA receptor encephalitis: A case series
2024, Journal of NeuroimmunologyLong-term Outcome Following Electroconvulsive Therapy for Late-Life Depression: Five-Year Follow-up Data From the MODECT Study
2022, American Journal of Geriatric PsychiatryWhich residual symptoms predict relapse after successful electroconvulsive therapy for late-life depression?
2022, Journal of Psychiatric ResearchCitation Excerpt :This could be related to the fact that ECT for LLD has been shown to be associated with clinically significant cognitive deficits confined to the time period during and immediately after the acute ECT course (Kumar et al., 2016). This transient cognitive impairment seems to involve aspects of attention and processing speed (Kumar et al., 2016). Consequently, the reported ‘concentration difficulties’ could be a cognitive effect of ECT rather than a residual depressive symptom.
Longitudinal Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Pharmacotherapy in Major Depressive Disorder in Older Adults: Phase 2 of the PRIDE Study
2022, American Journal of Geriatric PsychiatryTransient Cognitive Impairment and White Matter Hyperintensities in Severely Depressed Older Patients Treated With Electroconvulsive Therapy
2021, American Journal of Geriatric PsychiatryCitation Excerpt :Some of the patients also experience retrograde and anterograde amnesia, a decline in verbal memory or diminished executive functioning. A subset of patients show transient cognitive impairment, which is a longer period of significant decline in cognitive functioning during the ECT course, lasting from days to weeks,10,12–14 and which recovers as the depressive symptoms remit.14–16 Previously, Obbels et al. demonstrated that cognitive functioning could improve during the ECT course together with a reduction of the depressive symptoms, even in patients with low cognitive functioning at baseline.17