1. Transient Cognitive Impairment and White Matter Hyperintensities in Severely Depressed Older Patients Treated With Electroconvulsive Therapy
- Author
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Frederik Barkhof, Filip Bouckaert, Annemieke Dols, Pascal Sienaert, Eric van Exel, Didi Rhebergen, Max L. Stek, Dick J. Veltman, Sigfried N.T.M. Schouws, Mardien L. Oudega, Kristof Vansteelandt, Aartjan T.F. Beekman, Rein Postma, Jasmien Obbels, Margot J. Wagenmakers, Psychiatry, Neurology, APH - Aging & Later Life, APH - Mental Health, Amsterdam Neuroscience - Mood, Anxiety, Psychosis, Stress & Sleep, Amsterdam Neuroscience - Neurodegeneration, Radiology and nuclear medicine, Amsterdam Neuroscience - Brain Imaging, Amsterdam Neuroscience - Neuroinfection & -inflammation, and Anatomy and neurosciences
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,late life depression ,Grey matter ,behavioral disciplines and activities ,Electroconvulsive therapy ,Internal medicine ,mental disorders ,Humans ,Medicine ,Cognitive Dysfunction ,Prospective Studies ,Electroconvulsive Therapy ,structural MRI ,Aged ,Mini–Mental State Examination ,medicine.diagnostic_test ,Depression ,business.industry ,Brain morphometry ,transient cognitive impairment ,Brain ,Cognition ,white matter hyperintensities ,Late life depression ,medicine.disease ,White Matter ,Hyperintensity ,Psychiatry and Mental health ,medicine.anatomical_structure ,Mood disorders ,Cardiology ,severe depression ,Geriatrics and Gerontology ,business - Abstract
BACKGROUND: Although electroconvulsive therapy (ECT) is a safe and effective treatment for patients with severe late life depression (LLD), transient cognitive impairment can be a reason to discontinue the treatment. The aim of the current study was to evaluate the association between structural brain characteristics and general cognitive function during and after ECT. METHODS: A total of 80 patients with LLD from the prospective naturalistic follow-up Mood Disorders in Elderly treated with Electroconvulsive Therapy study were examined. Magnetic resonance imaging scans were acquired before ECT. Overall brain morphology (white and grey matter) was evaluated using visual rating scales. Cognitive functioning before, during, and after ECT was measured using the Mini Mental State Examination (MMSE). A linear mixed-model analysis was performed to analyze the association between structural brain alterations and cognitive functioning over time. RESULTS: Patients with moderate to severe white matter hyperintensities (WMH) showed significantly lower MMSE scores than patients without severe WMH (F(1,75.54) = 5.42, p = 0.02) before, during, and post-ECT, however their trajectory of cognitive functioning was similar as no time × WMH interaction effect was observed (F(4,65.85) = 1.9, p = 0.25). Transient cognitive impairment was not associated with medial temporal or global cortical atrophy (MTA, GCA). CONCLUSION: All patients showed a significant drop in cognitive functioning during ECT, which however recovered above baseline levels post-ECT and remained stable until at least 6 months post-ECT, independently of severity of WMH, GCA, or MTA. Therefore, clinicians should not be reluctant to start or continue ECT in patients with severe structural brain alterations. ispartof: American Journal Of Geriatric Psychiatry vol:29 issue:11 pages:1117-1128 ispartof: location:England status: accepted
- Published
- 2021