Predicting Retrograde Autobiographical Memory Changes Following Electroconvulsive Therapy: Relationships between Individual, Treatment, and Early Clinical Factors.

Donel M Martin,Colleen K Loo,Verònica Gálvez

doi:10.1093/ijnp/pyv067

Donel M Martin, Colleen K Loo + Show 1 more

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https://doi.org/10.1093/ijnp/pyv067

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Abstract

Background:Loss of personal memories experienced prior to receiving electroconvulsive therapy is common and distressing and in some patients can persist for many months following treatment. Improved understanding of the relationships between individual patient factors, electroconvulsive therapy treatment factors, and clinical indicators measured early in the electroconvulsive therapy course may help clinicians minimize these side effects through better management of the electroconvulsive therapy treatment approach. In this study we examined the associations between the above factors for predicting retrograde autobiographical memory changes following electroconvulsive therapy.Methods:Seventy-four depressed participants with major depressive disorder were administered electroconvulsive therapy 3 times per week using either a right unilateral or bitemporal electrode placement and brief or ultrabrief pulse width. Verbal fluency and retrograde autobiographical memory (assessed using the Columbia Autobiographical Memory Interview – Short Form) were tested at baseline and after the last electroconvulsive therapy treatment. Time to reorientation was measured immediately following the third and sixth electroconvulsive therapy treatments.Results:Results confirmed the utility of measuring time to reorientation early during the electroconvulsive therapy treatment course as a predictor of greater retrograde amnesia and the importance of assessing baseline cognitive status for identifying patients at greater risk for developing later side effects. With increased number of electroconvulsive therapy treatments, older age was associated with increased time to reorientation. Consistency of verbal fluency performance was moderately correlated with change in Columbia Autobiographical Memory Interview – Short Form scores following right unilateral electroconvulsive therapy.Conclusions:Electroconvulsive therapy treatment techniques associated with lesser cognitive side effects should be particularly considered for patients with lower baseline cognitive status or older age.

Highlights

Despite significant advances in electroconvulsive therapy (ECT) technique, memory side effects continue to be of major concern for patients and clinicians
Change in retrograde autobiographical memory was significantly associated with baseline global cognitive functioning, pulse width, reorientation time at post ECT 3 and 6, and consistency of verbal fluency performance
This study found that monitoring of reorientation time during the ECT course was a greater predictor of retrograde autobiographical memory changes at post ECT than other patient and treatment factors that are mostly established at the outset of treatment

Summary

Introduction

Despite significant advances in electroconvulsive therapy (ECT) technique, memory side effects continue to be of major concern for patients and clinicians. Memory loss may include specific events, details about events, or thoughts and feelings experienced during the missing periods The severity of these side effects, can be potentially reduced through the tailoring of ECT treatment parameters according to individual patient factors and the modification of treatment parameters during the ECT course based on early clinical indicators. The choice of ECT electrode placements is important, as montages that minimize the degree of temporal lobe stimulation, including right unilateral (RUL), have been found beneficial for reducing memory side effects (Sackeim et al, 1993; Sobin et al, 1995; Dunne and McLoughlin, 2012). Conclusions: Electroconvulsive therapy treatment techniques associated with lesser cognitive side effects should be considered for patients with lower baseline cognitive status or older age

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