{"id":544,"date":"2024-11-11T08:04:19","date_gmt":"2024-11-11T08:04:19","guid":{"rendered":"https:\/\/dutchectconsortium.nl\/?p=544"},"modified":"2024-12-04T18:53:50","modified_gmt":"2024-12-04T18:53:50","slug":"predictors-of-cognitive-side-effects-2","status":"publish","type":"post","link":"https:\/\/dutchectconsortium.nl\/index.php\/2024\/11\/11\/predictors-of-cognitive-side-effects-2\/","title":{"rendered":"Monitoring of cognitive side-effects"},"content":{"rendered":"<style>.kb-row-layout-id544_f0280f-6d > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id544_f0280f-6d > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id544_f0280f-6d > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:900px;padding-top:25px;padding-bottom:85px;grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id544_f0280f-6d{background-color:#fff;}.kb-row-layout-id544_f0280f-6d > .kt-row-layout-overlay{opacity:0.30;}.kb-row-layout-id544_f0280f-6d .kt-row-layout-bottom-sep{height:100px;}.kb-row-layout-id544_f0280f-6d .kt-row-layout-bottom-sep svg{width:100%;}.kb-row-layout-id544_f0280f-6d .kt-row-layout-bottom-sep svg{fill:#ffffff!important;}@media all and (max-width: 1024px){.kb-row-layout-id544_f0280f-6d > .kt-row-column-wrap{grid-template-columns:repeat(2, minmax(0, 1fr));}}@media all and (max-width: 1024px){.kb-row-layout-id544_f0280f-6d .kt-row-layout-bottom-sep{height:px;}}@media all and (max-width: 1024px){.kb-row-layout-id544_f0280f-6d .kt-row-layout-bottom-sep svg{width:%;}}@media all and (max-width: 767px){.kb-row-layout-id544_f0280f-6d > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id544_f0280f-6d .kt-row-layout-bottom-sep{height:px;}.kb-row-layout-id544_f0280f-6d .kt-row-layout-bottom-sep svg{width:%;}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id544_f0280f-6d alignnone kt-row-has-bg wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-2-columns kt-row-layout-row kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top kb-theme-content-width\">\n<style>.kadence-column544_25c8fd-19 > .kt-inside-inner-col,.kadence-column544_25c8fd-19 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column544_25c8fd-19 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column544_25c8fd-19{position:relative;}<\/style>\n<div class=\"wp-block-kadence-column kadence-column544_25c8fd-19 inner-column-2\"><div class=\"kt-inside-inner-col\">\n<p class=\"has-larger-font-size\">The sensitivity of the Mini-Mental State Examination to detect objective cognitive side-effects induced by electroconvulsive therapy, results from the Dutch ECT Consortium<\/p>\n\n\n\n<p class=\"has-text-align-left has-small-font-size\">D. Loef, P.F.P. van Eijndhoven, S.N.T.M. Schouws, A.J.C. Slooter, N. Janssen, R.M. Kok, B.P.F. Rutten, E. van Exel, D. Rhebergen, M.L. Oudega, R.J.T. Mocking, I. Tendolkar, A. Dols*, E. Verwijk*<br>* Shared supervision<\/p>\n\n\n\n<h3 class=\"wp-block-heading has-regular-font-size\" id=\"st0010\" style=\"font-style:normal;font-weight:100;text-transform:none\"><strong>Background<\/strong>: Monitoring cognitive side-effects following electroconvulsive therapy (ECT) is crucial for balancing side-effects and clinical effectiveness. Unfortunately, evidence-based guidelines on cognitive testing following ECT are lacking. A frequently used test in global ECT practice is the Mini Mental State Examination (MMSE). We examined the change of the MMSE and its performance in identifying a decline in predefined neuropsychological measures sensitive to ECT-induced cognitive changes: verbal recall and verbal fluency.<br><strong>Methods<\/strong>: The mean MMSE scores pre- and one week post-ECT were compared using a Wilcoxon signed-rank test. The Reliable Change Index was calculated for all cognitive measures to indicate whether an individual\u2019s change score from pre- to post-ECT is considered statistically significant. The sensitivity and specificity of the MMSE were calculated.<br><strong>Results<\/strong>: 426 patients with depression from five sites were included from the Dutch ECT Consortium. The mean MMSE increased significantly from 26.2 (SD=3.9) pre-ECT to 26.8 (SD=3.8) post-ECT (p=0.002). 36 patients (8.5%) showed a significant decline in MMSE score post-ECT. The sensitivity of the MMSE in identifying patients who experienced a significant decline in verbal recall or verbal fluency ranged from 3.6% to 11.1%. The specificity of the MMSE in identifying patients who did not experience a significant decline in verbal recall or verbal fluency ranged from 95.6% to 96.6%.<br><strong>Conclusions<\/strong>: Given the very low sensitivity of the MMSE, we propose reconsidering the prominence of the MMSE in ECT practice and cognitive monitoring guidelines, advocating for a more comprehensive approach to assess ECT-induced cognitive changes.<\/h3>\n\n\n\n<div class=\"wp-block-file\"><a id=\"wp-block-file--media-3ca79e72-7d6d-423b-8a54-c8289d9cbb53\" href=\"https:\/\/dutchectconsortium.nl\/wp-content\/uploads\/2024\/11\/1-s2.0-S2451902224002362-main.pdf\"><strong>Click here to download the article<\/strong><\/a><a href=\"https:\/\/dutchectconsortium.nl\/wp-content\/uploads\/2024\/11\/1-s2.0-S2451902224002362-main.pdf\" class=\"wp-block-file__button wp-element-button\" download aria-describedby=\"wp-block-file--media-3ca79e72-7d6d-423b-8a54-c8289d9cbb53\">Download<\/a><\/div>\n\n\n\n<p><a href=\"Abstract\nIntroduction: Major depressive disorder (MDD) is a common psychiatric disorder. Despite several treatment options, a subgroup of patients will not respond to\nthe commonly used antidepressant treatments and thus express treatment resistance (TRD). TRD can be quantified with the Dutch Measure for Treatment Resistance in Depression (DM-TRD). Electroconvulsive therapy (ECT) is an effective\ntreatment for MDD, also in TRD. Yet, the position of ECT as \u201ctreatment-of-lastresort\u201d may decrease the likelihood of beneficial outcome. Our aim was to investigate the association between treatment resistance and outcome and course of ECT.\nMethods: We performed a retrospective, multicenter cohort study with\n440 patients of which data was retrieved from patient records as collected in\nthe Dutch ECT Cohort database. Linear and logistic regression models were\nused to explore the association between level of treatment resistance and outcome of ECT. Median split was used to explore the differences between high\nand low level of TRD and course of treatment.\nResults: A higher DM-TRD score was associated with significantly smaller\nreduction of depression symptoms (R2 = 0.160; \u03b2 = \u00012.968; p < 0.001) and\nlower chance of response (OR = 0.821 [95 CI: 0.760\u20130.888]; \u03b2 = \u00010.197;\np < 0.001). Low level TRD patients underwent fewer ECT sessions (mean 13\n\u00b1 6 SD vs. 16 \u00b1 7 SD; p < 0.001) and fewer switches from right unilateral tot\nbifrontotemporal electrode placement (29% vs. 40%; p = 0.032).\nConclusion: Reserving ECT as \u201ctreatment-of-last-resort\u201d in the treatment\nalgorithm for MDD seems questionable, because in our study lower level of\ntreatment resistance predicted more beneficial ECT-outcome. Moreover, providing ECT in less treatment resistant patients showed fewer needed ECTsessions and less switches to BL electrode placement, which may decrease the\nrisk for cognitive side-effects.\"><br><br><\/a><\/p>\n<\/div><\/div>\n\n\n<style>.kadence-column544_2a672c-90 > .kt-inside-inner-col,.kadence-column544_2a672c-90 > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}.kadence-column544_2a672c-90 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column544_2a672c-90{position:relative;}<\/style>\n<div class=\"wp-block-kadence-column kadence-column544_2a672c-90\"><div class=\"kt-inside-inner-col\"><\/div><\/div>\n\n<\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>The sensitivity of the Mini-Mental State Examination to detect objective cognitive side-effects induced by electroconvulsive therapy, results from the Dutch ECT Consortium D.&hellip;<\/p>\n","protected":false},"author":1,"featured_media":564,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[],"class_list":["post-544","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-research"],"_links":{"self":[{"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/posts\/544","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/comments?post=544"}],"version-history":[{"count":4,"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/posts\/544\/revisions"}],"predecessor-version":[{"id":570,"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/posts\/544\/revisions\/570"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/media\/564"}],"wp:attachment":[{"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/media?parent=544"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/categories?post=544"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/dutchectconsortium.nl\/index.php\/wp-json\/wp\/v2\/tags?post=544"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}