Neuroscience and Psychiatry Unit, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Newcastle University, Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.
Psychol Med. 2021 Jul;51(10):1647-1656. doi: 10.1017/S0033291720000379. Epub 2020 Feb 27.
As uncertainty remains about whether clinical response influences cognitive function after electroconvulsive therapy (ECT) for depression, we examined the effect of remission status on cognitive function in depressed patients 4 months after a course of ECT.
A secondary analysis was undertaken on participants completing a randomised controlled trial of ketamine augmentation of ECT for depression who were categorised by remission status (MADRS ⩽10 v. >10) 4 months after ECT. Cognition was assessed with self-rated memory and neuropsychological tests of anterograde verbal and visual memory, autobiographical memory, verbal fluency and working memory. Patients were assessed through the study, healthy controls on a single occasion, and compared using analysis of variance.
At 4-month follow-up, remitted patients (N = 18) had a mean MADRS depression score of 3.8 (95% CI 2.2-5.4) compared with 27.2 (23.0-31.5) in non-remitted patients (N = 19), with no significant baseline differences between the two groups. Patients were impaired on all cognitive measures at baseline. There was no deterioration, with some measures improving, 4-months after ECT, at which time remitted patients had significantly improved self-rated memory, anterograde verbal memory and category verbal fluency compared with those remaining depressed. Self-rated memory correlated with category fluency and autobiographical memory at follow-up.
We found no evidence of persistent impairment of cognition after ECT. Achieving remission improved subjective memory and verbal memory recall, but other aspects of cognitive function were not influenced by remission status. Self-rated memory may be useful to monitor the effects of ECT on longer-term memory.
由于电抽搐治疗（ECT）后临床反应是否影响认知功能仍存在不确定性，我们研究了缓解状态对 ECT 疗程后 4 个月时抑郁患者认知功能的影响。
对接受氯胺酮增强 ECT 治疗的抑郁症患者进行了一项随机对照试验的二次分析，这些患者根据 ECT 后 4 个月的缓解状态（MADRS ⩽10 与 >10）进行分类。认知功能通过自我评估记忆和神经心理学测试进行评估，包括顺行言语和视觉记忆、自传体记忆、言语流畅性和工作记忆。患者在研究期间接受评估，健康对照组仅在一次就诊时接受评估，并通过方差分析进行比较。
在 4 个月的随访中，缓解组（N=18）的平均 MADRS 抑郁评分为 3.8（95%CI 2.2-5.4），而非缓解组（N=19）为 27.2（23.0-31.5），两组之间在基线时没有显著差异。患者在基线时所有认知测量均受损。ECT 后 4 个月没有恶化，一些测量值有所改善，此时缓解组的自我评估记忆、顺行言语记忆和类别言语流畅性明显优于持续抑郁的患者。自我评估记忆与类别流畅性和自传体记忆在随访时相关。
我们没有发现 ECT 后认知功能持续受损的证据。达到缓解状态可改善主观记忆和言语记忆回忆，但认知功能的其他方面不受缓解状态的影响。自我评估记忆可能有助于监测 ECT 对长期记忆的影响。
