title: Multifactorial determinants of the neurocognitive effects of electroconvulsive therapy.
abstract: For many patients with neuropsychiatric illnesses, standard psychiatric treatments with mono or combination pharmacotherapy, psychotherapy, and transcranial magnetic stimulation are ineffective. For these patients with treatment-resistant neuropsychiatric illnesses, a main therapeutic option is electroconvulsive therapy (ECT). Decades of research have found ECT to be highly effective; however, it can also result in adverse neurocognitive effects. Specifically, ECT results in disorientation after each session, anterograde amnesia for recently learned information, and retrograde amnesia for previously learned information. Unfortunately, the neurocognitive effects and underlying mechanisms of action of ECT remain poorly understood. The purpose of this paper was to synthesize the multiple moderating and mediating factors that are thought to underlie the neurocognitive effects of ECT into a coherent model. Such factors include demographic and neuropsychological characteristics, neuropsychiatric symptoms, ECT technical parameters, and ECT-associated neurophysiological changes. Future research is warranted to evaluate and test this model, so that these findings may support the development of more refined clinical seizure therapy delivery approaches and efficacious cognitive remediation strategies to improve the use of this important and widely used intervention tool for neuropsychiatric diseases.
authors.affiliation: From the *Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC; †Department of Psychology and Neuroscience, Duke University, Durham, NC; ‡Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX and §Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY.
authors.forename: Shawn M
authors.initials: SM
authors.lastname: McClintock
authors.forename: Jimmy
authors.initials: J
authors.lastname: Choi
authors.forename: Zhi-De
authors.initials: ZD
authors.lastname: Deng
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Appelbaum
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krystal
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Lisanby
mesh_terms: D003072:Cognition Disorders / Q000209:etiology*; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D001523:Mental Disorders / Q000150:complications / Q000628:therapy*; D009483:Neuropsychological Tests; D012307:Risk Factors