Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Int J Geriatr Psychiatry. 2017 May;32(5):522-531. doi: 10.1002/gps.4702. Epub 2017 Mar 10.
Electroconvulsive therapy (ECT) is an effective treatment for severe late-life depression; however, ECT-induced cognitive side effects frequently occur. The cholinergic system is thought to play an important role in the pathogenesis. We systematically reviewed the evidence for acetylcholinesterase inhibitors (Ache-I) to prevent or reduce ECT-induced cognitive side effects.
A systematic search was performed in Pubmed, EMBASE, PsychINFO, and the Cochrane database to identify clinical trials investigating the effect of Ache-I on ECT-induced cognitive side effects. Key search terms included all synonyms for ECT and Ache-I. Risk of bias assessment was conducted by using the Cochrane Collaboration's tool.
Five clinical trials were eligible for inclusion. All studies focused on cognitive functioning as primary endpoint, but assessment of cognitive functioning varied widely in time point of assessment and in cognitive tests that were used. There was also great variety in study medication, route and time of administration and dosages, duration of drug administration, and ECT techniques. Finally, only two out of five studies were considered at low risk of bias. Despite the aforementioned shortcomings, without exception, all studies demonstrated significantly better cognitive performance in individuals treated with Ache-I.
Despite large heterogeneity in studies, Ache-I appear to have beneficial effects on ECT-induced cognitive side effects, supporting an association with the cholinergic system in ECT-induced cognitive impairment. Methodological sound studies controlling for putative confounders are warranted. Copyright © 2017 John Wiley & Sons, Ltd.
电痉挛疗法（ECT）是治疗严重老年期抑郁症的有效方法；然而，ECT 引起的认知副作用经常发生。胆碱能系统被认为在发病机制中起着重要作用。我们系统地回顾了乙酰胆碱酯酶抑制剂（Ache-I）预防或减少 ECT 引起的认知副作用的证据。
在 Pubmed、EMBASE、PsychINFO 和 Cochrane 数据库中进行了系统搜索，以确定研究 Ache-I 对 ECT 引起的认知副作用影响的临床试验。关键搜索词包括 ECT 和 Ache-I 的所有同义词。使用 Cochrane 协作工具进行偏倚风险评估。
有五项临床试验符合纳入标准。所有研究均将认知功能作为主要终点，但认知功能的评估在评估时间点和使用的认知测试方面差异很大。研究药物、给药途径和时间、用药持续时间以及 ECT 技术也存在很大差异。最后，只有五项研究中的两项被认为具有低偏倚风险。尽管存在上述缺点，但无一例外，所有研究都表明，接受 Ache-I 治疗的个体的认知表现明显更好。
尽管研究存在很大的异质性，但 Ache-I 似乎对 ECT 引起的认知副作用有有益的影响，支持了它与 ECT 引起的认知障碍中的胆碱能系统的关联。需要进行有控制潜在混杂因素的方法学良好的研究。
