Evaluating the Utility of Electroconvulsive Therapy Cognitive Assessment during and after Electroconvulsive Therapy Open Access

Ye, Zixun (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/bn999737g?locale=en



Evaluating the Utility of Electroconvulsive Therapy Cognitive Assessment during and after Electroconvulsive Therapy

By: Zixun Ye

Introduction: Electroconvulsive therapy (ECT) is a widespread treatment for major depression, however patients may experience memory loss as a side effect of ECT. A commonly used tool for assessing cognitive function and memory in patients receiving ECT is the Montreal Cognitive Assessment (MoCA). However, it ignores some aspects of the cognitive deficits related to ECT. Electroconvulsive Therapy Cognitive Assessment (ECCA) was developed to address these limitations. The goal of this paper is to perform statistical analysis to investigate the utility of ECCA in detecting cognitive change in patients receiving ECT and determine whether ECCA is a better assessment tool than MoCA.

Methods: Patients with major depression receiving ECT were administrated the ECCA and MoCA at three study phases: baseline (pre-ECT), before the sixth ECT treatment (mid-ECT), and after at least one week from the last treatment (post-ECT). Paired t-tests were used to assess changes in ECCA and MoCA scores between pairs of study phases. Repeated measures analyses were conducted to evaluate the changes of ECCA and MoCA scores across the three study phases, without and with adjustments for confounders, including number of ECT treatment and total number of bilateral lead placement. We examined the association between depression severity and ECCA scores based on two-sample t-tests. We also applied agreement measures to assess the inter-rater reliability of ECCA based on baseline data collected from patients without ECT and healthy controls.

Results: ECCA scores demonstrate a sensible decreasing trend over time, which evidences the cognitive change related to ECT treatments (P<0.001). In contrast, MoCA score show significant changes across the three study phases (P=0.03) however in the counter-intuitive increasing direction. ECCA scores were significantly different from MoCA scores at mid-ECT and post-ECT phases(P<.001). Number of ECT treatments and bilateral lead placement are found to have negative impact on ECCA (P<.05) while not on MoCA. Lin's concordance correlation coefficient of 0.84 (95% CI: [0.71, 0.92]) suggests good inter-rater reliability of ECCA and further supports its repruducibility in clinical use.

Discussions: ECCA provides an easy, quick, reliable cognitive screening tool for patients undergoing ECT and has good sensitivity to detect memory loss during and after the administration of ECT.

Table of Contents

Table of Contents

1. Introduction 1

2. Methods 5

2.1 Demographic Characteristics 5

2.2 Evaluating ECCA and MoCA at 3 study phases 5

2.3 Assessment agreement between ECCA and MoCA and inter-rater reliability of ECCA 6

2.4 The relation between depression with performance of ECCA assessment 7

3. Results 8

3.1 Study Participants and Characteristics 8

3.2 Evaluating ECCA and MoCA across Three Study Phases in Depressed Patients Undergoing ECT 9

3.3 Comparison between ECCA and MoCA in Each Time Phase 9

3.4 Comparison in Overall Score of ECCA with MoCA and Memory Domains in 3 Phases 9

3.5 Effect of Total Number of ECT Treatments on ECCA and MoCA and Major Cognitive Domains 12

3.6 Effect of Total Number of Bilateral (BL) Placements on ECCA and MoCA and Major Cognitive Domains 12

3.7 Internal Consistency in Depressed without ECT group and Healthy Normal group 13

3.8 Inter-rater Reliability 14

4. Discussions and Concluding Remarks 15

4.1 ECCA Versus MoCA on Identifying Cognitive Change during ECT 15

4.2 Evaluation for Major Domains 16

4.3 Impact of Total Number of ECT Treatments 17

4.4 Impact of Total Number of Bilateral Lead Placements 18

4.5 Internal Consistency and Inter-rater Reliability 18

4.6 Conclusions 19

4.7 Strengths and Limitations 20

4.8 Recommendations 19

References 20

Appendix A: Tables and Figures 24

Appendix B: Tables 31

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