title: The Clinical Practice of Assessing Cognitive Function in Adults Receiving Electroconvulsive Therapy: Whom Are We Missing?
abstract: BACKGROUND
  Cognition can be affected by electroconvulsive therapy (ECT). Good clinical practice includes neuropsychological assessment, although this is seldom a part of routine clinical practice. It looks like a substantial part of patients fail to complete cognitive assessments. This constitutes a problem in the generalizability of published clinical research on cognitive side effects. Most studies of ECT-related cognitive adverse effects do not discuss this important issue of so-called cognitive test nonparticipants. Recent findings suggest that cognitive test nonparticipants are more severely ill, and probably more vulnerable to cognitive side effects.
  
  
  OBJECTIVE
  To examine the feasibility of a neuropsychological test battery in daily clinical practice, in an adult population referred for ECT.
  
  
  METHODS
  We reviewed the clinical records of 84 patients referred for ECT. Demographic and clinical characteristics of those patients who were able to complete our routine cognitive testing at baseline are compared with those who could not complete the assessment.
  
  
  RESULTS
  From 84 ECT patients, 60 (71%) completed a pre-ECT cognitive assessment, whereas 24 (29%) did not. Patients with a unipolar depression, with psychotic symptoms, who started their treatment with a bitemporal electrode placement were more likely to be test noncompleters than test completers.
  
  
  CONCLUSIONS
  Patients with a unipolar depression, with psychotic features, who are treated with a bitemporal electrode placement, have a higher likelihood of not completing a pre-ECT cognitive assessment. These patients probably represent a subgroup more vulnerable to cognitive side effects.
authors.affiliation: From the *Academic Center for ECT and Neuromodulation, and †Department of Mood Disorders, University Psychiatric Centre, Campus Kortenberg, Kortenberg; ‡Center for the Psychology of Learning and Experimental Psychopathology, University of Leuven, Leuven; §Department of Old Age Psychiatry, University Psychiatric Centre, University of Leuven, Campus Kortenberg, Kortenberg, Belgium; and ∥Department of Old Age Psychiatry, and ¶Department of ECT, Parnassia Psychiatric Institute, The Hague, The Netherlands.
authors.forename: Jasmien
authors.initials: J
authors.lastname: Obbels
authors.forename: Koen
authors.initials: K
authors.lastname: Vanbrabant
authors.forename: Filip
authors.initials: F
authors.lastname: Bouckaert
authors.forename: Esmée
authors.initials: E
authors.lastname: Verwijk
authors.forename: Pascal
authors.initials: P
authors.lastname: Sienaert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002389:Catatonia / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology*; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods / Q000523:psychology*; D004566:Electrodes; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000209:etiology / Q000523:psychology; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D055815:Young Adult