title: Short- and long-term neurocognitive functioning after electroconvulsive therapy in depressed elderly: a prospective naturalistic study.
abstract: BACKGROUND
  It is generally assumed that the elderly patients are more vulnerable to cognitive side effects after electroconvulsive therapy (ECT) than younger depressed patients. The current study aims to evaluate the nature and extent of changes across multiple domains of neurocognitive functioning in a group of elderly depressed patients after ECT.
  
  
  METHODS
  In this prospective naturalistic study, we included 42 depressed patients aged ≥55 years. Global cognitive function, memory, and executive function were assessed before ECT treatment and within one week (short-term post-ECT) and six months after ECT (long-term post-ECT). Associations between cognitive functioning and electrode placement, total number of treatment sessions, age, and the severity of depression at the time of cognitive measurement were studied.
  
  
  RESULTS
  Our data offered no evidence of decline for any of the neurocognitive tests after ECT, given its power to detect the difference. Post-ECT improvement of neurocognitive functioning was statistically significant for the Mini-Mental State Examination, Visual Association Test, 10 Words Verbal Learning Test, and Expanded Mental Control Test. Effect sizes were medium to large. After six months, compared with post-ECT performance, statistically significant improvement was found only for the Trail Making Test-A and the Letter Fluency Test with small to medium effect sizes.
  
  
  CONCLUSIONS
  In our severely depressed elderly patients, neurocognitive performance improved or did not change after ECT. Patients with poor cognitive function were not able to participate in neuropsychological assessment before ECT started. Consequently these results may not apply to patients with more severe cognitive impairment prior to the start of ECT.
authors.affiliation: ECT Department, Clinical Center for the Elderly, Parnassia Psychiatric Institute, the Hague, the Netherlands.
authors.forename: Esmée
authors.initials: E
authors.lastname: Verwijk
authors.affiliation: GGZinGeest/VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Hannie C
authors.initials: HC
authors.lastname: Comijs
authors.affiliation: ECT Department, Clinical Center for the Elderly, Parnassia Psychiatric Institute, the Hague, the Netherlands.
authors.forename: Rob M
authors.initials: RM
authors.lastname: Kok
authors.affiliation: ECT Department, Clinical Center for the Elderly, Parnassia Psychiatric Institute, the Hague, the Netherlands.
authors.forename: Harm-Pieter
authors.initials: HP
authors.lastname: Spaans
authors.affiliation: Tergooiziekenhuizen, Blaricum/Hilversum, the Netherlands.
authors.forename: Caroline E M
authors.initials: CE
authors.lastname: Tielkes
authors.affiliation: Department of Clinical Neuropsychology, VU University, Amsterdam, the Netherlands.
authors.forename: Erik J A
authors.initials: EJ
authors.lastname: Scherder
authors.affiliation: GGZinGeest/VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
mesh_terms: D000368:Aged; D003072:Cognition Disorders / Q000209:etiology / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods; D056344:Executive Function; D005260:Female; D006801:Humans; D007361:Intelligence Tests; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D013997:Time Factors; D016896:Treatment Outcome