Clinical
D.P. Devanand, Tirumalasetti,
Fughik
The
Research
cognitive received to those
function
scores
more than of matched
and
M.D., Anil K. Verma, M.D., M.D., and Harold A. Sackeim,
subjective
1 00 treatments patients who
J Psychiatry
1991;
memory
with had
patients given many ECT treatments over nitive impairment at long-term follow-up. (Am
York
ter, Willard, New York);
State
State Psychiatric Physicians and reprint requests
atry, St.,
Office
of Mental
Box 72, New
J
Health
(Willard
Psychiatric
Cen-
Center for Geriatrics, Psychiatry, New York
Institute, and Department of Psychiatry, College of Surgeons, Columbia University, New York. Address to Dr. Devanand, Department of Biological Psychi-
York
State
New York, NY 10032. Copyright © 1991 American
Am
received Dec. 17, 1990; accepted Psychiatry Fellowship Program,
N.Y., and Columbia University and the Department of Biological
Psychiatry
148:7,
Psychiatric Psychiatric
July
1991
ofeight
patients
courses
do
not
manifest
who
had
were equivsuggest that
measurable
cog-
148:929-932)
ognitive impairments after a series of ECT have been well characterized (1). After ECT, many patients have anterograde and retrograde memory deficits that typically resolve within a few months after treatment (2). Permanent effects appear to be restricted to gaps in memory for events that transpired during the months surrounding the ECT course (2). Nonetheless, at long-term follow-up a small minority of patients report profound cognitive deterioration, which they attribute to ECT, although objective neunopsychological evaluations may not reveal significant deficits (2, 3). Virtually all modern studies of ECT cognitive effects have involved patients who were each given a single course of ECT (2). Early studies with patients who received large numbers of ECT treatments suffered from a number of methodological problems: nonblind evaluation of ECT patients and comparison subjects (4, 5), group differences in severity of psychopathol-
Received May 21, 1990; revision Jan. 28, 1991. From the Geriatric
complaints
Ph.D.
bilateral modified sine wave ECT never received ECT. The results
several
C
New
Reports
Absence of Cognitive Impairment More Than 100 Lifetime ECT Treatments
After
each alent
and
Institute, Association.
722 West
168th
ogy, lack of clarity as to whether a prolonged single course on multiple courses of ECT were administered (4, 5), and use of inappropriate instruments for neuropsychological evaluation. In this early work, the patients were predominantly treated with unmodified ECT and their own perceptions of their cognitive functioning were not studied. In a controlled comparison, we gathered preliminary information on the severity of cognitive deficits and subjective memory complaints in patients who had received more than 100 treatments with bilateral modified sine wave ECT in their lifetimes.
METHOD The study was conducted at a large state facility in rural upstate New York. All living patients who had received more than 100 ECT treatments at the facility between 1965 and 1990 were identified. These 10 patients constituted less than 1 % of the patients who had been administered ECT during the 25-year period. Nine of these 10 patients were still followed at the facility at the time of study. Eight of them agreed to participate; the remaining patient was experiencing a manic episode and was not recruited for participation. The eight ECT patients were individually matched to eight patients who had never received ECT; matching was based on age, sex, psychiatric diagnosis, inpatient! outpatient status, and specific ward or outpatient clinic.
929
CLINICAL
AND
RESEARCH
REPORTS
TABLE 1. Demographic Characteristics Matched Patients Never Given ECT
and Cognition
Scores
for Eight
Patients
Given
More
Than
100
Lifetime
ECT Treatments
and
Comparison
ECT Variable
Mean
Descriptive variables Age (years) Education (years) Age at onset (years) Number of psychiatric hospitalizations Lifetime number of ECTs Number of ECT courses
Buschke Selective Total recall Delayed recall Recognition Subjective memory
Events Events Names Events Global Sum
Test
aire Test
SD
(df=7)
58.1 10.3 21.5 19.2 160.1 1 1 .8
12.1 2.3 8.8 13.8 58.8 4.8
58.5 11.8 42.6 3.9
13.0 3.3 13.5 3.2
0.34 0.83 2.87a 3.27”
38.7
41.3
30.9 I 1.3
9.6 10.6
26.0 6.1
5.7 3.3
2.64” 1.71
26.6
3.3
26.5
4.3
0.08
34.8 6.1
12.4 3.3
37.1 5.6
9.8 3.1
0.50 0.41
11.5
0.9
10.8
2.0
0.89
1.0 0.9 1.0 0.7 0.9
0.70 0.31 0.61 1.93 1.49
3.7
1.32
(six trials)
questionnaire
long ago a few minutes ago and faces of people a month from now of five
t
Mean
total
Reminding
Group SD
Months from last ECT to evaluation Psychopathology scores BPRS Montgomery-Asberg depression scale Cognition scores Mini-Mental State
Group
items
3.5 3.8 3.6 3.1 3.4
1.3 0.7 0.5 0.8 0.7
17.4
3.9 3.9 3.9 3.7 4.0
3.0
19.4
“p
D.P. Devanand, Tirumalasetti,
Fughik
The
Research
cognitive received to those
function
scores
more than of matched
and
M.D., Anil K. Verma, M.D., M.D., and Harold A. Sackeim,
subjective
1 00 treatments patients who
J Psychiatry
1991;
memory
with had
patients given many ECT treatments over nitive impairment at long-term follow-up. (Am
York
ter, Willard, New York);
State
State Psychiatric Physicians and reprint requests
atry, St.,
Office
of Mental
Box 72, New
J
Health
(Willard
Psychiatric
Cen-
Center for Geriatrics, Psychiatry, New York
Institute, and Department of Psychiatry, College of Surgeons, Columbia University, New York. Address to Dr. Devanand, Department of Biological Psychi-
York
State
New York, NY 10032. Copyright © 1991 American
Am
received Dec. 17, 1990; accepted Psychiatry Fellowship Program,
N.Y., and Columbia University and the Department of Biological
Psychiatry
148:7,
Psychiatric Psychiatric
July
1991
ofeight
patients
courses
do
not
manifest
who
had
were equivsuggest that
measurable
cog-
148:929-932)
ognitive impairments after a series of ECT have been well characterized (1). After ECT, many patients have anterograde and retrograde memory deficits that typically resolve within a few months after treatment (2). Permanent effects appear to be restricted to gaps in memory for events that transpired during the months surrounding the ECT course (2). Nonetheless, at long-term follow-up a small minority of patients report profound cognitive deterioration, which they attribute to ECT, although objective neunopsychological evaluations may not reveal significant deficits (2, 3). Virtually all modern studies of ECT cognitive effects have involved patients who were each given a single course of ECT (2). Early studies with patients who received large numbers of ECT treatments suffered from a number of methodological problems: nonblind evaluation of ECT patients and comparison subjects (4, 5), group differences in severity of psychopathol-
Received May 21, 1990; revision Jan. 28, 1991. From the Geriatric
complaints
Ph.D.
bilateral modified sine wave ECT never received ECT. The results
several
C
New
Reports
Absence of Cognitive Impairment More Than 100 Lifetime ECT Treatments
After
each alent
and
Institute, Association.
722 West
168th
ogy, lack of clarity as to whether a prolonged single course on multiple courses of ECT were administered (4, 5), and use of inappropriate instruments for neuropsychological evaluation. In this early work, the patients were predominantly treated with unmodified ECT and their own perceptions of their cognitive functioning were not studied. In a controlled comparison, we gathered preliminary information on the severity of cognitive deficits and subjective memory complaints in patients who had received more than 100 treatments with bilateral modified sine wave ECT in their lifetimes.
METHOD The study was conducted at a large state facility in rural upstate New York. All living patients who had received more than 100 ECT treatments at the facility between 1965 and 1990 were identified. These 10 patients constituted less than 1 % of the patients who had been administered ECT during the 25-year period. Nine of these 10 patients were still followed at the facility at the time of study. Eight of them agreed to participate; the remaining patient was experiencing a manic episode and was not recruited for participation. The eight ECT patients were individually matched to eight patients who had never received ECT; matching was based on age, sex, psychiatric diagnosis, inpatient! outpatient status, and specific ward or outpatient clinic.
929
CLINICAL
AND
RESEARCH
REPORTS
TABLE 1. Demographic Characteristics Matched Patients Never Given ECT
and Cognition
Scores
for Eight
Patients
Given
More
Than
100
Lifetime
ECT Treatments
and
Comparison
ECT Variable
Mean
Descriptive variables Age (years) Education (years) Age at onset (years) Number of psychiatric hospitalizations Lifetime number of ECTs Number of ECT courses
Buschke Selective Total recall Delayed recall Recognition Subjective memory
Events Events Names Events Global Sum
Test
aire Test
SD
(df=7)
58.1 10.3 21.5 19.2 160.1 1 1 .8
12.1 2.3 8.8 13.8 58.8 4.8
58.5 11.8 42.6 3.9
13.0 3.3 13.5 3.2
0.34 0.83 2.87a 3.27”
38.7
41.3
30.9 I 1.3
9.6 10.6
26.0 6.1
5.7 3.3
2.64” 1.71
26.6
3.3
26.5
4.3
0.08
34.8 6.1
12.4 3.3
37.1 5.6
9.8 3.1
0.50 0.41
11.5
0.9
10.8
2.0
0.89
1.0 0.9 1.0 0.7 0.9
0.70 0.31 0.61 1.93 1.49
3.7
1.32
(six trials)
questionnaire
long ago a few minutes ago and faces of people a month from now of five
t
Mean
total
Reminding
Group SD
Months from last ECT to evaluation Psychopathology scores BPRS Montgomery-Asberg depression scale Cognition scores Mini-Mental State
Group
items
3.5 3.8 3.6 3.1 3.4
1.3 0.7 0.5 0.8 0.7
17.4
3.9 3.9 3.9 3.7 4.0
3.0
19.4
“p
