Anterograde Verbal Memory Research Articles

The utility of the brief ECT cognitive screen (BECS) for early prediction of cognitive adverse effects from ECT: A CARE network study

Although highly effective, electroconvulsive therapy (ECT) often produces cognitive side effects which can be a barrier for patients. Monitoring cognitive side effects during the acute course is therefore recommended to identify patients at increased risk for adverse outcomes. The Brief ECT Cognitive Screen (BECS) is a brief instrument designed to measure emerging cognitive side effects from ECT. The aim of this study was to examine the clinical utility of the BECS for predicting adverse cognitive outcomes in real world clinic settings. The study included data collated from four participating sites in the Clinical Alliance for ECT and Related treatments (CARE) network. The BECS was administered at pre ECT and post 3 or 4 ECT. The primary outcome was a ≥4 point decrease on the Montreal Cognitive Assessment (MoCA) from pretreatment to post ECT. Logistic multiple regression analyses examined the BECS and other relevant clinical and demographic and treatment factors as predictors. The final analysis included 623 patients with diverse indications for ECT including 53.6% with major depression and 33.7% with schizophrenia or schizoaffective disorder. A higher total score on the BECS significantly predicted decline in Total Scores on the MoCA [B = 0.25 (0.08), p = 0.003], though not decline in MoCA Delayed Recall scores (p > 0.1). Other significant predictors included higher pretreatment MoCA Total Scores and female gender for verbal anterograde memory decline. This study confirmed that the BECS has clinical utility for identifying patients with both reduced and increased risk for adverse cognitive outcomes from ECT.

Cognitive function after electroconvulsive therapy for depression: relationship to clinical response.

As uncertainty remains about whether clinical response influences cognitive function after electroconvulsive therapy (ECT) for depression, we examined the effect of remission status on cognitive function in depressed patients 4 months after a course of ECT. A secondary analysis was undertaken on participants completing a randomised controlled trial of ketamine augmentation of ECT for depression who were categorised by remission status (MADRS ⩽10 v. >10) 4 months after ECT. Cognition was assessed with self-rated memory and neuropsychological tests of anterograde verbal and visual memory, autobiographical memory, verbal fluency and working memory. Patients were assessed through the study, healthy controls on a single occasion, and compared using analysis of variance. At 4-month follow-up, remitted patients (N = 18) had a mean MADRS depression score of 3.8 (95% CI 2.2-5.4) compared with 27.2 (23.0-31.5) in non-remitted patients (N = 19), with no significant baseline differences between the two groups. Patients were impaired on all cognitive measures at baseline. There was no deterioration, with some measures improving, 4-months after ECT, at which time remitted patients had significantly improved self-rated memory, anterograde verbal memory and category verbal fluency compared with those remaining depressed. Self-rated memory correlated with category fluency and autobiographical memory at follow-up. We found no evidence of persistent impairment of cognition after ECT. Achieving remission improved subjective memory and verbal memory recall, but other aspects of cognitive function were not influenced by remission status. Self-rated memory may be useful to monitor the effects of ECT on longer-term memory.

A systematic review and computational modelling analysis of unilateral montages in electroconvulsive therapy.

To examine the clinical outcomes of ECT unilateral placements compared in prior studies and apply insights from computational modelling to understand differences between placements. PubMed, Embase, Scopus and PsycINFO and reference lists were systematically searched for studies of depressed patients where two unilateral placements were compared and clinical outcomes were reported. Computational modelling was done to generate electric field maps for each unilateral placement identified in the systematic review. A total of 29 studies met criteria for inclusion. Eight studies reported efficacy outcomes and 23 studies reported cognitive outcomes. Most studies found no significant difference in efficacy between right unilateral (RUL) and left unilateral (LUL) ECT, and no difference was found between temporo-parietal and fronto-temporal ECT. For the majority of studies, RUL placements had better verbal anterograde memory outcomes compared with the LUL placements. There was some evidence suggestive of cognitive advantages for fronto-frontal and fronto-parietal placements relative to temporo-parietal ECT. For efficacy, studies mainly focused on the comparison of right vs. left hemispheric stimulation, with the available evidence suggesting no substantive difference. RUL placements tended to have better verbal anterograde memory outcomes relative to LUL placements, though limited differences were found between the RUL placements.

Study protocol for the randomised controlled trial: Ketamine augmentation of ECT to improve outcomes in depression (Ketamine-ECT study).

BackgroundThere is a robust empirical evidence base supporting the acute efficacy of electroconvulsive therapy (ECT) for severe and treatment resistant depression. However, a major limitation, probably contributing to its declining use, is that ECT is associated with impairment in cognition, notably in anterograde and retrograde memory and executive function. Preclinical and preliminary human data suggests that ketamine, used either as the sole anaesthetic agent or in addition to other anaesthetics, may reduce or prevent cognitive impairment following ECT. A putative hypothesis is that ketamine, through antagonising glutamate receptors, protects from excess excitatory neurotransmitter stimulation during ECT. The primary aim of the ketamine-ECT study is to investigate whether adjunctive ketamine can attenuate the cognitive impairment caused by ECT. Its secondary aim is to examine if ketamine increases the speed of clinical improvement with ECT.Methods/DesignThe ketamine ECT study is a multi-site randomised, placebo-controlled, double blind trial. It was originally planned to recruit 160 moderately to severely depressed patients who had been clinically prescribed ECT. This recruitment target was subsequently revised to 100 patients due to recruitment difficulties. Patients will be randomly allocated on a 1:1 basis to receive either adjunctive ketamine or saline in addition to standard anaesthesia for ECT. The primary neuropsychological outcome measure is anterograde verbal memory (Hopkins Verbal Learning Test-Revised delayed recall task) after 4 ECT treatments. Secondary cognitive outcomes include verbal fluency, autobiographical memory, visuospatial memory and digit span. Efficacy is assessed using observer and self-report efficacy measures of depressive symptomatology. The effects of ECT and ketamine on cortical activity during cognitive tasks will be studied in a sub-sample using functional near-infrared spectroscopy (fNIRS).DiscussionThe ketamine-ECT study aims to establish whether or not adjunctive ketamine used together with standard anaesthesia for ECT will significantly reduce the adverse cognitive effects observed after ECT. Potential efficacy benefits of increased speed of symptom improvement and a reduction in the number of ECT treatments required will also be assessed, as will safety and tolerability of adjunctive ketamine. This study will provide important evidence as to whether adjunctive ketamine is routinely indicated for ECT given for depression in routine NHS clinical practice.Trial RegistrationCurrent Controlled Trials: ISRCTN14689382 (assigned 30/07/2012); EudraCT Number: 2011-005476-41

Cognitive Side-effects of Electroconvulsive Therapy in Elderly Depressed Patients

Knowledge about cognitive side-effects induced by electroconvulsive therapy (ECT) in depressed elderly patients is sparse. In this study we investigated changes in the cognitive functioning of non-demented elderly depressed patients receiving ECT (n = 62) compared with healthy elderly people (n = 17). Neuropsychological tests were administered at the start of treatment and again within 1 week after treatment. We computed reliable change indices (RCIs) using simple regression methods. RCIs are statistical methods for analyzing change in individuals that have not yet been used in studies of the acute cognitive side-effects of ECT. At the group level, only letter fluency performance was found to be significantly reduced in the ECT group compared with the controls, whereas both groups demonstrated stable or improved performance on all other measures. At the individual level, however, 11% of patients showed retrograde amnesia for public facts post-ECT and 40% of the patients showed a significant decline in neuropsychological functioning. Decline on a measure of delayed verbal anterograde memory was most common. Our findings indicate that there are mild neurocognitive impairments in the acute phase for a substantial minority of elderly patients receiving ECT. Analysis of reliable change facilitated the illumination of cognitive side-effects in our sample.

Amélioration mnésique postopératoire un an après traitement chirurgical de l’épilepsie du lobe temporal

Several studies have assessed the impact of surgery on both anterograde and remote memory in patients with temporal lobe epilepsy (TLE). The majority of results have shown an extensive memory deficit in patients after temporal resection (TL). However, few protocols have used a prospective longitudinal design. Moreover, the postoperative delays were variable from one study to the next, instead of regular monitoring to identify the potential effect of time elapsed after surgery on memory performance. In addition, some studies have not used strict inclusion criteria to establish homogeneous patient groups. Finally, the impact of surgery on memory has been often assessed by comparing memory skills between epileptic patients and healthy controls. Our aim was to examine the impact of TL on memory in patients with TLE, recruited according to clear-cut clinical criteria. Moreover, we focused on memory performance progression per se in epileptic patients pre- and postoperatively, rather than on memory performance analysis expressed as "deficient" or "normal". We assessed 30 patients with unilateral TLE (17 right TLE and 13 left TLE) on four anterograde memory tests and six remote memory tasks. Patients completed all tests preoperatively, and 5 and 12 months after TL. Five months after surgery, performance was equivalent to the preoperative scores for both groups in anterograde memory tasks and remote memory tests. One year after TL, patients with right TLE showed enhanced performance in the verbal anterograde memory tests and in retrieving recent autobiographical memories. Results for left TL showed improved scores only in a recognition memory test of faces. In the present study, surgical patients were "double winners" gaining seizure freedom and potential of memory stability or recovery. The gain was observed only 12 months after surgery and following temporal resection lateralisation. Our data showed postoperative memory improvement in patients with temporal lobe epilepsy presenting with specific clinical characteristics.

A Two-Year Follow-Up Study of Remote Memory in Alzheimer's Disease

The authors assessed long-term changes in autobiographical and public remote memory in a series of 21 patients with Alzheimer's disease (AD) and 10 age-comparable healthy comparison subjects who underwent two evaluations, with an interval ranging from 24 to 36 months. The assessment consisted of the Remote and Autobiographical Memory Scales and the Buschke Selective Reminding Test. The AD group showed a significantly greater decline on both types of remote memory than the comparison group. Alzheimer's disease patients performed significantly better on recognition than on free-recall, suggesting more severe retrieval than encoding/storage deficits. The decline in anterograde verbal memory correlated significantly with the decline in autobiographical memory, suggesting a common final pathway for both deficits.

A Two-Year Follow-Up Study of Remote Memory in Alzheimer's Disease

The authors assessed long-term changes in autobiographical and public remote memory in a series of 21 patients with Alzheimer's disease (AD) and 10 age-comparable healthy comparison subjects who underwent two evaluations, with an interval ranging from 24 to 36 months. The assessment consisted of the Remote and Autobiographical Memory Scales and the Buschke Selective Reminding Test. The AD group showed a significantly greater decline on both types of remote memory than the comparison group. Alzheimer's disease patients performed significantly better on recognition than on free-recall, suggesting more severe retrieval than encoding/storage deficits. The decline in anterograde verbal memory correlated significantly with the decline in autobiographical memory, suggesting a common final pathway for both deficits.

How good at neurology are you?

1. Read the case history and suggest a diagnostic test and result. A 48-year-old butcher suffered three epileptic seizures within a few weeks, followed by a 2-month history of irritability, agitation and aggressive behaviour – leading to psychiatric assessment. Soon thereafter, executive cognitive disturbances and anterograde verbal memory difficulties with a mild right hemiparesis developed, without fever, headache or signs of raised intracranial pressure. There were no stroke like events. General medical examination, routine laboratory investigations, ESR, auto antibodies and HIV negative. Chest Xray and CT abdomen normal. Figures a and b shows two slices of the MR FLAIR sequence. The CSF was acellular, protein 0.73 g/L, PCR negative for JC and herpes viruses. There was minimal enhancement of the right parietal and left fronto-parietal lesions. The neuroradiological opinion was of an inflammatory, rather than neoplastic disorder. A diagnostic test was performed. 2. Where is the lesion causing this appearance? See

Dissociation dans l’atteinte de la mémoire rétrograde dans un cas d’encéphalite herpétique

Objective: To report an uncommon case of memory impairment after meningoencephalitis. Method: Detailed description of the history, the lesions, the evolution and review of the bibliography. Results: A 33 year-old man showed a loss of verbal anterograde memory and a dissociation of retrograde memory impairment after an herpetic meningo-encephalitis with lesions predominant in the left temporal lobe. The patient had impairment of verbal anterograde memory. Visual memory, procedural one were intact. He had normal performances in frontal tests. Neuropsychological assessment revealed major loss of episodic biographical memory and public events memory, but sparing of semantic biographical memory and professional knowledge. This patient who was amnesic but who had not difficulties with visual memory, procedural memory, frontal abilities and didactic memory conserved ability to work. Conclusion: This case report emphasize the multiplicity of the memory systems and the likely links between episodic biographical memory, semantic biographical memory, autobiographic episodic memory, public event memory and didactic memory.

Differential Mechanisms of Impairment of Remote Memory in Alzheimer’s and Frontotemporal Dementia

This paper describes retrograde memory performances of 12 Alzheimer’s disease (AD) patients and 12 frontotemporal dementia (FTD) patients. First of all, we observed that FTD and AD patients did not differ for language tests (verbal fluency tests and oral denomination 80), for semantic memory tests, for logical memory test and Benton visual memory test and differed for anterograde verbal memory and frontal tests. Concerning retrograde memory, there was no difference between AD and FTD patients in retrograde memory scores (autobiographical memory interview, Crovitz’s task, French public events interview battery) and both FTD and AD patients exhibited a retrieval deficit in their remote memory. We observed that the mechanisms of remote memory deficit was different in FTD and in AD patients. We observed no classical paradigm of Ribot for FTD patient’s remote informations, and they appeared to have lost of access to memories and executive difficulties. In AD, the results indicated these patients’ ability to learn new information and to search semantic memory failed.

Spinocerebellar degeneration (SCD): cognitive disturbances

The performance of 30 patients younger than 65 years with spinocerebellar degeneration (SCD) was compared with control subjects matched for age, sex, and education in standardized neuropsychological tests. SCD patients exhibited abnormalities in WAIS, in the recall test of anterograde verbal memory, in verbal fluency, in visuospatial function and on the depression scale. However, they exhibited no deficit in the recognition test of anterograde verbal memory. No patients showed impaired visual confrontation naming. The pattern of neuropsychological deficits exhibited by the SCD patients closely approximated the profile observed in other types of subcortical dementia. There were no significant differences between the SCD patients with pontine atrophy and those without pontine atrophy in any of the neuropsychological examinations.