Memory and cognitive effects of ECT: informing and assessing patients^†

Abstract

Over the past few years electroconvulsive therapy (ECT) has come under increased scrutiny in the UK, with the first systematic review of patients' experiences and new national guidelines. Our aim in this article is to translate recent and sometimes confusing research and policy statements into practical guidance that benefits patients. We examined the evidence on the permanent memory and cognitive effects of ECT, with a focus on delineating their nature, understanding how ECT may cause them, informing prospective patients about them, and assessing their impact on former patients. We describe a simple and effective method for assessing retrograde amnesia. Data do not exist at this time to confirm the mechanisms by which ECT exerts its adverse effects, but clinicians should fully inform patients of the possible permanent adverse effects of the treatment, which include amnesia, memory disability and cognitive disability, and should provide follow-up testing using relevant instruments.

Professional accounts of electroconvulsive therapy: A discourse analysis

“…Moreover, the viewing of memory problems as resulting from depression rather than ECT seems a little dated -the consensus view from a range of studies does appear to demonstrate a range of cognitive problems following ECT administration (McElhiney, Moody, Steif, Prudic, Devanand, Nobler & Sackheim, 1995;Neylan, Canick, Hall, Reus, Sapolsky & Wolkowitz, 2001;Robertson & Pryor, 2006).…”

“…Service users could be provided with specific information about the type of accounts which they might expect prescribing clinicians to draw on during discussions about ECT. Robertson and Pryor (2006) have provided a useful format for discussing the benefits and risks associated with ECT with mental health service users.…”

Cognitive rehabilitation: assessment and treatment of persistent memory impairments following ECT

“…What is striking from the literature in this area is the lack of routine, formal assessment of patients' neuropsychological performance following a course of ECT, despite the long-known risk to memory Post-ECT cognitive impairment functioning Freeman et al, 1980;Squire & Slater, 1983;Robertson & Pryor, 2006). Furthermore, the lack of consistency in the types of measures used to assess patients has made it difficult to clarify the extent and duration of the reported cognitive problems and the impact they may have on the individual's overall quality of life and sense of self.…”

“…Designing an assessment battery that is sensitive to the nature of the everyday problems experienced by patients with memory and/or cognitive disability is challenging, and standard neuropsychological tests may not adequately reflect the levels of impairment experienced by patients on a daily basis (Robertson & Pryor, 2006). Thus, the use of novel, personally relevant memory tasks such as those described below may be warranted.…”

Late-onset depression: issues affecting clinical care

“…However, identifying and monitoring cogni tive symptoms may be particularly important in this vulnerable group. Robertson & Pryor (2006) suggest the use of various neuropsychological batteries for testing cognitive function following ECT.…”