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Short- and long-term neurocognitive functioning after electroconvulsive therapy in depressed elderly: a prospective naturalistic study

Published online by Cambridge University Press:  26 November 2013

Esmée Verwijk ,
Hannie C. Comijs ,
Rob M. Kok ,
Harm-Pieter Spaans ,
Caroline E.M. Tielkes ,
Erik J.A. Scherder  and
Max L. Stek
Esmée Verwijk*
Affiliation:
ECT Department, Clinical Center for the Elderly, Parnassia Psychiatric Institute, the Hague, the Netherlands
Hannie C. Comijs
Affiliation:
GGZinGeest/VU University Medical Center, Amsterdam, the Netherlands
Rob M. Kok
Affiliation:
ECT Department, Clinical Center for the Elderly, Parnassia Psychiatric Institute, the Hague, the Netherlands
Harm-Pieter Spaans
Affiliation:
ECT Department, Clinical Center for the Elderly, Parnassia Psychiatric Institute, the Hague, the Netherlands
Caroline E.M. Tielkes
Affiliation:
Tergooiziekenhuizen, Blaricum/Hilversum, the Netherlands
Erik J.A. Scherder
Affiliation:
Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands
Max L. Stek
Affiliation:
GGZinGeest/VU University Medical Center, Amsterdam, the Netherlands
*
Correspondence should be addressed to: Esmée Verwijk, MSc, ECT Department, Clinical Center for the Elderly, Parnassia Psychiatric Institute, Mangostraat 1, 2552 KS the Hague, the Netherlands. Phone: +31-(0)88-357-6681. Email: E.Verwijk@parnassia.nl.
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Abstract

Background:

It is generally assumed that the elderly patients are more vulnerable to cognitive side effects after electroconvulsive therapy (ECT) than younger depressed patients. The current study aims to evaluate the nature and extent of changes across multiple domains of neurocognitive functioning in a group of elderly depressed patients after ECT.

Methods:

In this prospective naturalistic study, we included 42 depressed patients aged ≥55 years. Global cognitive function, memory, and executive function were assessed before ECT treatment and within one week (short-term post-ECT) and six months after ECT (long-term post-ECT). Associations between cognitive functioning and electrode placement, total number of treatment sessions, age, and the severity of depression at the time of cognitive measurement were studied.

Results:

Our data offered no evidence of decline for any of the neurocognitive tests after ECT, given its power to detect the difference. Post-ECT improvement of neurocognitive functioning was statistically significant for the Mini-Mental State Examination, Visual Association Test, 10 Words Verbal Learning Test, and Expanded Mental Control Test. Effect sizes were medium to large. After six months, compared with post-ECT performance, statistically significant improvement was found only for the Trail Making Test-A and the Letter Fluency Test with small to medium effect sizes.

Conclusions:

In our severely depressed elderly patients, neurocognitive performance improved or did not change after ECT. Patients with poor cognitive function were not able to participate in neuropsychological assessment before ECT started. Consequently these results may not apply to patients with more severe cognitive impairment prior to the start of ECT.

Keywords

elderlydepressioncognitioncognitive impairmentmemoryneuropsychiatryelectroconvulsive therapy (ECT)
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 2 , February 2014 , pp. 315 - 324
Copyright
Copyright © International Psychogeriatric Association 2013 

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