Department of Emergency Medicine, Peking University Sixth Hospital, Beijing, China; School of Nursing, Peking University, Beijing, China.
Department of Nursing, Peking University Sixth Hospital, Beijing, China.
Psychiatry Res. 2024 Jan;331:115611. doi: 10.1016/j.psychres.2023.115611. Epub 2023 Dec 1.
Electroconvulsive therapy (ECT) is endorsed as a principal treatment approach for major depressive disorder (MDD) worldwide. Despite prior studies highlighting potential short-term cognitive deficits post-ECT, the debate regarding its long-term implications persists. This study endeavors to elucidate the reasons for this contention using an evidence-based approach.
This investigation, meticulously aligned with PRISMA guidelines, was prospectively enlisted on PROSPERO (CRD42023439259). A comprehensive search was performed across various databases, including PubMed, Cochrane Library, Web of Science, Embase, SCOPUS, PsycINFO, CINAHL Plus, and OpenGrey. This review, traversing the literature from inception until June 2023, encapsulated 10 studies (five RCTs and five quasi-experimental studies) involving a cohort of 868 individuals diagnosed with major depressive disorder.
The meta-analysis revealed that the persistent discourse on ECT-induced long-term cognitive impairment chiefly emanates from the inadequacies in the specificity and sensitivity of conventional assessment instruments. Conversely, subgroup analyses showed that cognitive impairment in ECT, as gauged by the nascent assessment tool, Electroconvulsive Therapy Cognitive Assessment (ECCA) (SMD = -0.94, 95 % CI [-1.33, -0.54], p < 0.00001), exerted a detrimental influence on the long-term trajectory of individuals with MDD. Notably, there was an adverse effect of ECT on the subdomain of long-term learning cognitive abilities in patients with MDD (SMD = -0.37, 95 % CI [-0.55, -0.18], p < 0.0001). Contrarily, memory (SMD = 0.16, 95 % CI [-0.02, 0.34], p = 0.08), attention (SMD = 0.23, 95 % CI [-0.07, 0.54], p = 0.14), language (SMD = -0.10, 95 % CI [-0.25, 0.05], p = 0.19), spatial perception, and orientation (SMD = -0.04, 95 % CI [-0.28, 0.20], p = 0.75) exhibited no significant detriments. Intriguingly, ECT showed favorable effects on executive function and processing speed among patients with MDD (SMD = 0.52, 95 % CI [0.29, 0.74], p < 0.00001).
This meta-analysis underscores ECCA's superior sensitivity of the ECCA compared to the MMSE or MoCA in detecting cognitive changes in patients with post-ECT MDD. Following Electroconvulsive Therapy (ECT), deterioration was observed in overall cognitive function and learning capabilities, while memory, attention, language, and spatial perception remained stable. Notably, enhancements were discerned in executive function and processing speed, which not only augmented academic perspectives but also steered the formulation of international clinical guidelines, accentuating the progressive role of ECT in the therapeutic approach to MDD.
电痉挛疗法（ECT）在全球范围内被认可为治疗重度抑郁症（MDD）的主要治疗方法。尽管先前的研究强调了 ECT 后可能存在短期认知缺陷，但关于其长期影响的争论仍在继续。本研究旨在通过循证方法阐明这一争议的原因。
本研究严格遵循 PRISMA 指南，前瞻性地在 PROSPERO（CRD42023439259）上进行了登记。对包括 PubMed、Cochrane 图书馆、Web of Science、Embase、SCOPUS、PsycINFO、CINAHL Plus 和 OpenGrey 在内的多个数据库进行了全面检索。本综述涵盖了从开始到 2023 年 6 月的文献，包括 10 项研究（5 项 RCT 和 5 项准实验研究），涉及 868 名确诊为 MDD 的患者。
荟萃分析表明，ECT 引起的长期认知损伤的持续争议主要源于传统评估工具的特异性和敏感性不足。相比之下，亚组分析表明，ECT 导致的认知损伤（根据新兴评估工具 Electroconvulsive Therapy Cognitive Assessment [ECCA] 评估）（SMD = -0.94，95%CI [-1.33，-0.54]，p < 0.00001）对 MDD 患者的长期轨迹产生了不利影响。值得注意的是，ECT 对 MDD 患者的长期学习认知能力亚域产生了不利影响（SMD = -0.37，95%CI [-0.55，-0.18]，p < 0.0001）。相反，记忆（SMD = 0.16，95%CI [-0.02，0.34]，p = 0.08）、注意力（SMD = 0.23，95%CI [-0.07，0.54]，p = 0.14）、语言（SMD = -0.10，95%CI [-0.25，0.05]，p = 0.19）、空间感知和定向（SMD = -0.04，95%CI [-0.28，0.20]，p = 0.75）无显著损害。有趣的是，ECT 对 MDD 患者的执行功能和处理速度产生了有益影响（SMD = 0.52，95%CI [0.29，0.74]，p < 0.00001）。
本荟萃分析强调了 ECCA 相对于 MMSE 或 MoCA 在检测 ECT 后 MDD 患者认知变化方面的更高敏感性。在进行电痉挛治疗（ECT）后，患者的整体认知功能和学习能力出现恶化，而记忆、注意力、语言和空间感知能力保持稳定。值得注意的是，执行功能和处理速度有所提高，这不仅增加了学术观点，还推动了国际临床指南的制定，强调了 ECT 在 MDD 治疗方法中的不断进步作用。
