title: White matter hyperintensities and cognitive impairment during electroconvulsive therapy in severely depressed elderly patients.
abstract: OBJECTIVE
  Transient cognitive impairment during electroconvulsive therapy (ECT) can be a reason to discontinue ECT in depressed elderly patients. We hypothesized that both white matter hyperintensities and medial temporal lobe atrophy contribute to transient cognitive impairment during ECT.
  
  
  METHODS
  In 81 elderly patients with depression, magnetic resonance images (MRI) were recorded before ECT. We rated white matter hyperintensities (WMH) with the Age-Related White Matter Changes scale (ARWMC). Cognitive impairment during ECT was measured weekly with the Mini Mental State Examination (MMSE), 2 days after each session.
  
  
  RESULTS
  The mean MMSE score at baseline for all patients was 25.5 points, the lowest MMSE score during ECT was 23.3 points, and the mean MMSE score after ECT was 26.3 points. Stratification for the ECT method showed no significant difference in the lowest MMSE scores of patients with or without WMH, receiving unilateral ECT (22.5 points versus 23.9 points). There was a difference in the lowest MMSE scores in patients who switched from unilateral ECT to bilateral ECT (18.7 points in patients with WMH versus 22.0 points in patients without WMH).
  
  
  CONCLUSIONS
  Depressed elderly patients with WMH who receive bilateral ECT are at increased risk of transient cognitive impairment. Our findings show, however, that cognitive impairment improves when ECT is continued. This implies that ECT does not have to be discontinued when patients experience transient cognitive impairment during ECT.
authors.affiliation: Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research and VU University Medical Centre and GGZ in Geest, Amsterdam, The Netherlands. Electronic address: M.Oudega@ggzingeest.nl.
authors.forename: Mardien L
authors.initials: ML
authors.lastname: Oudega
authors.affiliation: Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research and VU University Medical Centre and GGZ in Geest, Amsterdam, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: van Exel
authors.affiliation: Department of Radiology, Department of Nuerology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Mike P
authors.initials: MP
authors.lastname: Wattjes
authors.affiliation: Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research and VU University Medical Centre and GGZ in Geest, Amsterdam, The Netherlands.
authors.forename: Hannie C
authors.initials: HC
authors.lastname: Comijs
authors.affiliation: Department of Radiology, Department of Nuerology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Philip
authors.initials: P
authors.lastname: Scheltens
authors.affiliation: Department of Radiology, Department of Nuerology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.affiliation: Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research and VU University Medical Centre and GGZ in Geest, Amsterdam, The Netherlands; Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Piet
authors.initials: P
authors.lastname: Eikelenboom
authors.affiliation: Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Anton J M
authors.initials: AJ
authors.lastname: de Craen
authors.affiliation: Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research and VU University Medical Centre and GGZ in Geest, Amsterdam, The Netherlands.
authors.forename: Aartjan T F
authors.initials: AT
authors.lastname: Beekman
authors.affiliation: Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research and VU University Medical Centre and GGZ in Geest, Amsterdam, The Netherlands.
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
mesh_terms: D017668:Age of Onset; D000368:Aged; D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000473:pathology* / Q000502:physiology; D003072:Cognition Disorders / Q000150:complications / Q000473:pathology*; D003863:Depression / Q000150:complications / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D059906:Neuroimaging; D009483:Neuropsychological Tests; D013702:Temporal Lobe / Q000473:pathology*
keywords: ECT; Medial temporal lobe atrophy; depression; elderly patients; white matter hyperintensities