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Short- and long-term neurocognitive functioning after electroconvulsive therapy in depressed elderly: a prospective naturalistic study

  • Esmée Verwijk (a1), Hannie C. Comijs (a2), Rob M. Kok (a1), Harm-Pieter Spaans (a1), Caroline E.M. Tielkes (a3), Erik J.A. Scherder (a4) and Max L. Stek (a2)...



It is generally assumed that the elderly patients are more vulnerable to cognitive side effects after electroconvulsive therapy (ECT) than younger depressed patients. The current study aims to evaluate the nature and extent of changes across multiple domains of neurocognitive functioning in a group of elderly depressed patients after ECT.


In this prospective naturalistic study, we included 42 depressed patients aged ≥55 years. Global cognitive function, memory, and executive function were assessed before ECT treatment and within one week (short-term post-ECT) and six months after ECT (long-term post-ECT). Associations between cognitive functioning and electrode placement, total number of treatment sessions, age, and the severity of depression at the time of cognitive measurement were studied.


Our data offered no evidence of decline for any of the neurocognitive tests after ECT, given its power to detect the difference. Post-ECT improvement of neurocognitive functioning was statistically significant for the Mini-Mental State Examination, Visual Association Test, 10 Words Verbal Learning Test, and Expanded Mental Control Test. Effect sizes were medium to large. After six months, compared with post-ECT performance, statistically significant improvement was found only for the Trail Making Test-A and the Letter Fluency Test with small to medium effect sizes.


In our severely depressed elderly patients, neurocognitive performance improved or did not change after ECT. Patients with poor cognitive function were not able to participate in neuropsychological assessment before ECT started. Consequently these results may not apply to patients with more severe cognitive impairment prior to the start of ECT.


Corresponding author

Correspondence should be addressed to: Esmée Verwijk, MSc, ECT Department, Clinical Center for the Elderly, Parnassia Psychiatric Institute, Mangostraat 1, 2552 KS the Hague, the Netherlands. Phone: +31-(0)88-357-6681. Email:


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Baba, al. (2010). Executive dysfunction in remitted late-life depression: Juntendo University Mood Disorder Projects (JUMP). Journal of Neuropsychiatry and Clinical Neurosciences, 22, 7074. doi:10.1176/appi.neuropsych.22.1.70.
Bayless, J. D., McCormick, L. M., Brumm, M. C., Espe-Pfeifer, P. B., Long, J. J. and Lewis, J. L. (2010). Pre- and post-electroconvulsive therapy multidomain cognitive assessment in psychotic depression: relationship to premorbid abilities and symptom improvement. Journal of ECT, 26, 4752. doi:10.1097/YCT.0b013e3181ac8ec2.
Brodaty, H., Berle, D., Hickie, I. and Mason, C. (2001). “Side effects” of ECT are mainly depressive phenomena and are independent of age. Journal of Affective Disorders, 66, 237245.
Brodaty, H., Hickie, I., Mason, C. and Prenter, L. (2000). A prospective follow-up study of ECT outcome in older depressed patients. Journal of Affective Disorders, 60, 101111.
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Hillsdale, NJ: Laurence Earlbaum.
Flint, A. J. and Gagnon, N. (2002). Effective use of electroconvulsive therapy in late-life depression. Canadian Journal of Psychiatry, 47, 734741.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Fraser, L. M., O’Carroll, R. E. and Ebmeier, K. P. (2008). The effect of electroconvulsive therapy on autobiographical memory: a systematic review. Journal of ECT, 24, 1017. doi:10.1097/YCT.0b013e3181616c26.
Gallagher, P., Robinson, L. J., Gray, J. M., Porter, R. J. and Young, A. H. (2007). Neurocognitive function following remission in major depressive disorder: potential objective marker of response? Australian and New Zealand Journal of Psychiatry, 41, 5461. doi:10.1080/00048670601057734.
Gardner, B. K. and O’Connor, D. W. (2008). A review of the cognitive effects of electroconvulsive therapy in older adults. Journal of ECT, 24, 6880. doi:10.1097/YCT.0b013e318165c7b0.
Hausner, L., Damian, M., Sartorius, A. and Frolich, L. (2011). Efficacy and cognitive side effects of electroconvulsive therapy (ECT) in depressed elderly inpatients with coexisting mild cognitive impairment or dementia. Journal of Clinical Psychiatry, 72, 9197. doi:10.4088/JCP.10m05973gry.
IBM (2012). SPSS Statistics 20. Somers, NY: IBM.
Ingram, A., Saling, M. M. and Schweitzer, I. (2008). Cognitive side effects of brief pulse electroconvulsive therapy: a review. Journal of ECT, 24, 39. doi:10.1097/YCT.0b013e31815ef24a.
Kellner, C. al. (2010). Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial. British Journal of Psychiatry, 196, 226234. doi:10.1192/bjp.bp.109.066183.
Kohler, S., Thomas, A. J., Barnett, N. A. and O’Brien, J. T. (2010). The pattern and course of cognitive impairment in late-life depression. Psychological Medicine, 40, 591602. doi:10.1017/S0033291709990833.
Lindeboom, J., Koene, T. and Matto, D. (1993). The diagnostic value of tests for mental control. Tijdschrift voor Gerontologie en Geriatrie, 24, 105109.
Lindeboom, J., Schmand, B., Tulner, L., Walstra, G. and Jonker, C. (2002). Visual association test to detect early dementia of the Alzheimer's type. Journal of Neurology, Neurosurgery and Psychiatry, 73, 126133.
Loo, C., Katalinic, N., Martin, D. and Schweitzer, I. (2012). A review of ultrabrief pulse width electroconvulsive therapy. Therapeutic Advances in Chronic Disease, 3, 6985. doi:10.1177/2040622311432493.
Luteijn, F. and van der Ploeg, F. A. E. (1983). Groninger Intelligentie Test (GIT). Lisse, Netherlands: Swets & Zeitlinger.
McClintock, S. al. (2010). Evaluation of the effects of severe depression on global cognitive function and memory. CNS Spectrums, 15, 304313.
Montgomery, S. A. and Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382389.
NICE (2003). Guidance on the Use of Electroconvulsive Therapy Technology Appraisal 59. London: National Institute for Health and Clinical Excellence.
O’Connor, D. W., Gardner, B., Eppingstall, B. and Tofler, D. (2010). Cognition in elderly patients receiving unilateral and bilateral electroconvulsive therapy: a prospective, naturalistic comparison. Journal of Affective Disorders, 124, 235240. doi:10.1016/j.jad.2009.11.022.
Perneger, T. V. (1998). What's wrong with Bonferroni adjustments. BMJ (Clinical Research Ed.), 316, 12361238.
Petrides, G. and Fink, M. (1996). The “half-age” stimulation strategy for ECT dosing. Convulsive Therapy, 12, 138146.
Radloff, L. A. (1977). The CES-D scale: a Self-Report Depression Scale for research in the general population. Applied Psychological Measurement, 1, 385401.
Reitan, R. M. (1979). Trail-Making Test. Arizona: Reitan Neuropsychology Laboratory.
Rey, A. (1964). L’examen Clinique en Psychologie, 2 edn. Paris, France: Presses Universitaires de France.
Sackeim, H. A., Prudic, J., Fuller, R., Keilp, J., Lavori, P. W. and Olfson, M. (2007). The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology, 32, 244254. doi:10.1038/sj.npp.1301180.
Sackeim, H. al. (2008). Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. Brain Stimulation, 1, 7183. doi:10.1016/j.brs.2008.03.001.
Salzman, C., Wong, E. and Wright, B. C. (2002). Drug and ECT treatment of depression in the elderly, 1996–2001: a literature review. Biological Psychiatry, 52, 265284.
Schat, A., van den Broek, W. W., Mulder, P. G., Birkenhager, T. K., van Tuijl, R. and Murre, J. M. (2007). Changes in everyday and semantic memory function after electroconvulsive therapy for unipolar depression. Journal of ECT, 23, 153157. doi:10.1097/yct.0b013e318065aa0c.
Semkovska, M., Keane, D., Babalola, O. and McLoughlin, D. M. (2011). Unilateral brief-pulse electroconvulsive therapy and cognition: effects of electrode placement, stimulus dosage and time. Journal of Psychiatric Research, 45, 770780. doi:10.1016/j.jpsychires.2010.11.001.
Sienaert, P., Vansteelandt, K., Demyttenaere, K. and Peuskens, J. (2010). Randomized comparison of ultra-brief bifrontal and unilateral electroconvulsive therapy for major depression: cognitive side-effects. Journal of Affective Disorders, 122, 6067. doi:10.1016/j.jad.2009.06.011.
Stek, M. L., Wurff van der, F. F. B., Hoogendijk, W. J. G. and Beekman, A. T. F. (2009). Electroconvulsive therapy for the depressed elderly. Cochrane Database of Systematic Reviews, 1, 1.
Stoppe, A., Louza, M., Rosa, M., Gil, G. and Rigonatti, S. (2006). Fixed high-dose electroconvulsive therapy in the elderly with depression: a double-blind, randomized comparison of efficacy and tolerability between unilateral and bilateral electrode placement. Journal of ECT, 22, 9299.
Stoudemire, A., Hill, C. D., Morris, R., Martino-Saltzman, D. and Lewison, B. (1993). Long-term affective and cognitive outcome in depressed older adults. American Journal of Psychiatry, 150, 896900.
Strauss, E., Sherman, E. M. S. and Spreen, O. (2006). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. New York, NY: Oxford University Press.
Tew, J. D. Jr., Mulsant, B. H., Haskett, R. F., Dolata, D., Hixson, L. and Mann, J. J. (2002). A randomized comparison of high-charge right unilateral electroconvulsive therapy and bilateral electroconvulsive therapy in older depressed patients who failed to respond to 5 to 8 moderate-charge right unilateral treatments. Journal of Clinical Psychiatry, 63, 11021105.
Tielkes, C. E., Comijs, H. C., Verwijk, E. and Stek, M. L. (2008). The effects of ECT on cognitive functioning in the elderly: a review. International Journal of Geriatric Psychiatry, 23, 789795. doi:10.1002/gps.1989.
Verhage, F. (1964). Intelligentie en Leeftijd: Onderzoek bij Nederlanders van twaalf tot Zevenenzeventig jaar. Assen, Netherlands: Van Gorcum.
Verwijk, E., Comijs, H. C., Kok, R. M., Spaans, H. P., Stek, M. L. and Scherder, E. J. (2012). Neurocognitive effects after brief pulse and ultrabrief pulse unilateral electroconvulsive therapy for major depression: a review. Journal of Affective Disorders, 140, 233243. doi:10.1016/j.jad.2012.02.024.
Warren, E. W. and Groome, D. H. (1984). Memory test performance under three different waveforms of ECT for depression. British Journal of Psychiatry, 144, 370375.
Wechsler, D. (2000). WAIS-III Nederlandstalige Bewerking. Afname- en Scoringshandleiding. Lisse, Netherlands: Swets & Zeitlinger.
Weiland-Fiedler, al. (2004). Evidence for continuing neuropsychological impairments in depression. Journal of Affective Disorders, 82, 253258. doi:10.1016/j.jad.2003.10.009.
Wilson, B. A., Evans, J. J., Alderman, N., Burgess, P. W. and Emslie, H. (1997). Behavioural assessment of the dysexecutive syndrome. In Rabbitt, P. (ed.), Theory and Methodology of Frontal and Executive Function (pp. 239250). East Sussex, UK: Psychology Press.
Zervas, I. al. (1993). Age-dependent effects of electroconvulsive therapy on memory. Convulsive Therapy, 9, 3942.


Short- and long-term neurocognitive functioning after electroconvulsive therapy in depressed elderly: a prospective naturalistic study

  • Esmée Verwijk (a1), Hannie C. Comijs (a2), Rob M. Kok (a1), Harm-Pieter Spaans (a1), Caroline E.M. Tielkes (a3), Erik J.A. Scherder (a4) and Max L. Stek (a2)...


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