Sackeim Harold A, Prudic Joan, Fuller Rice, Keilp John, Lavori Philip W, Olfson Mark
Department of Biological Psychiatry, New York State Psychiatric Institute, New York, NY 10032, USA.
Neuropsychopharmacology. 2007 Jan;32(1):244-54. doi: 10.1038/sj.npp.1301180. Epub 2006 Aug 23.
Despite ongoing controversy, there has never been a large-scale, prospective study of the cognitive effects of electroconvulsive therapy (ECT). We conducted a prospective, naturalistic, longitudinal study of clinical and cognitive outcomes in patients with major depression treated at seven facilities in the New York City metropolitan area. Of 751 patients referred for ECT with a provisional diagnosis of a depressive disorder, 347 patients were eligible and participated in at least one post-ECT outcome evaluation. The primary outcome measures, Modified Mini-Mental State exam scores, delayed recall scores from the Buschke Selective Reminding Test, and retrograde amnesia scores from the Columbia University Autobiographical Memory Interview-SF (AMI-SF), were evaluated shortly following the ECT course and 6 months later. A substantial number of secondary cognitive measures were also administered. The seven sites differed significantly in cognitive outcomes both immediately and 6 months following ECT, even when controlling for patient characteristics. Electrical waveform and electrode placement had marked cognitive effects. Sine wave stimulation resulted in pronounced slowing of reaction time, both immediately and 6 months following ECT. Bilateral (BL) ECT resulted in more severe and persisting retrograde amnesia than right unilateral ECT. Advancing age, lower premorbid intellectual function, and female gender were associated with greater cognitive deficits. Thus, adverse cognitive effects were detected 6 months following the acute treatment course. Cognitive outcomes varied across treatment facilities and differences in ECT technique largely accounted for these differences. Sine wave stimulation and BL electrode placement resulted in more severe and persistent deficits.
尽管仍存在争议，但从未有过关于电休克疗法（ECT）认知效应的大规模前瞻性研究。我们对纽约市大都市区七个机构治疗的重度抑郁症患者的临床和认知结果进行了一项前瞻性、自然主义的纵向研究。在751名被转诊接受ECT且初步诊断为抑郁症的患者中，347名患者符合条件并参与了至少一次ECT后结果评估。主要结果指标，即改良简易精神状态检查分数、布施克选择性提醒测试中的延迟回忆分数以及哥伦比亚大学自传体记忆访谈简表（AMI-SF）中的逆行性遗忘分数，在ECT疗程结束后不久和6个月后进行了评估。还实施了大量次要认知指标。即使在控制患者特征的情况下，七个机构在ECT后即刻和6个月时的认知结果也存在显著差异。电波形和电极放置具有显著的认知效应。正弦波刺激在ECT后即刻和6个月时均导致反应时间明显减慢。双侧（BL）ECT比右侧单侧ECT导致更严重和持续的逆行性遗忘。年龄增长、病前智力功能较低以及女性性别与更大的认知缺陷相关。因此，在急性治疗疗程后6个月检测到了不良认知效应。认知结果因治疗机构而异，ECT技术的差异在很大程度上解释了这些差异。正弦波刺激和BL电极放置导致更严重和持续的缺陷。
