title: Acetylcholinesterase inhibitors for electroconvulsive therapy-induced cognitive side effects: a systematic review.
abstract: Electroconvulsive therapy (ECT) is an effective treatment for severe late-life depression; however, ECT-induced cognitive side effects frequently occur. The cholinergic system is thought to play an important role in the pathogenesis. We systematically reviewed the evidence for acetylcholinesterase inhibitors (Ache-I) to prevent or reduce ECT-induced cognitive side effects.
  
  
  
  A systematic search was performed in Pubmed, EMBASE, PsychINFO, and the Cochrane database to identify clinical trials investigating the effect of Ache-I on ECT-induced cognitive side effects. Key search terms included all synonyms for ECT and Ache-I. Risk of bias assessment was conducted by using the Cochrane Collaboration's tool.
  
  
  
  Five clinical trials were eligible for inclusion. All studies focused on cognitive functioning as primary endpoint, but assessment of cognitive functioning varied widely in time point of assessment and in cognitive tests that were used. There was also great variety in study medication, route and time of administration and dosages, duration of drug administration, and ECT techniques. Finally, only two out of five studies were considered at low risk of bias. Despite the aforementioned shortcomings, without exception, all studies demonstrated significantly better cognitive performance in individuals treated with Ache-I.
  
  
  
  Despite large heterogeneity in studies, Ache-I appear to have beneficial effects on ECT-induced cognitive side effects, supporting an association with the cholinergic system in ECT-induced cognitive impairment. Methodological sound studies controlling for putative confounders are warranted. Copyright © 2017 John Wiley & Sons, Ltd.
authors.affiliation: Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.|Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Marieke J
authors.identifier: 0000-0003-3207-8825
authors.initials: MJ
authors.lastname: Henstra
authors.affiliation: Medical Library, VU University Medical Center, Amsterdam, The Netherlands.|Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Elise P
authors.initials: EP
authors.lastname: Jansma
authors.affiliation: Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.|Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Nathalie
authors.initials: N
authors.lastname: van der Velde
authors.affiliation: Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.|Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands.|Department of Pharmacy, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Eleonora L
authors.initials: EL
authors.lastname: Swart
authors.affiliation: Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.|Department of Psychiatry, GGZ inGeest, EMGO+ Institute for Health and Care Research VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
authors.affiliation: Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.|Department of Psychiatry, GGZ inGeest, EMGO+ Institute for Health and Care Research VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Didi
authors.initials: D
authors.lastname: Rhebergen
mesh_terms: D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003072:Cognition Disorders / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D003866:Depressive Disorder / Q000628:therapy; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D006801:Humans; D016896:Treatment Outcome
chemical_list: D002800:Cholinesterase Inhibitors
keywords: acetylcholinesterase inhibitors; cognitive side effects; electroconvulsive therapy; systematic review