ECT had probable positive effects on visual memory and psychomotor speed, however this was no longer statistically significant after correction for multiple testing. More recently, a study of 31 adults inpatients with treatment-resistant schizophrenia undergoing adjunctive ECT found that ECT may have positive effects on some aspects of cognition, such as immediate and delayed verbal memory and executive functioning. However, the study was limited by its small sample and cognition was measured at least 4 months after the course of ECT. Similar results were found in a study comparing 10 patients on maintenance ECT for schizophrenia to matched controls. A small two-year follow-up study of nine adolescents with schizophrenia undergoing ECT, matched to nine controls, found no significant differences in cognitive scores (assessed using the Neuropsychological Assessment Scale) between the two groups at the two-year end-point.
More recent evidence suggests that ECT either has no significant effect on cognition, or may even improve cognition, in patients with schizophrenia. The review acknowledged that this conclusion is informed by only a small number of studies with small sample sizes.
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The Cochrane Review of ECT in schizophrenia concluded that the use of ECT seems to be associated with greater cognitive impairment immediately post-ECT when compared to conventional antipsychotics and this impairment appears to be transient. Some found subtle memory impairments in patients after ECT whilst others found no memory impairment at all. The effects of ECT on cognition for the treatment of schizophrenia are unclear. Deficits in social cognition are also present in individuals with schizophrenia and impact functioning. A review has found that cognitive deficits in schizophrenia appear distinct from positive and negative symptoms, with disorganization factors having the strongest association with cognitive test scores. Ĭognitive deficits are a core feature of schizophrenia with impact on social occupational functioning. Treatment-related factors such as higher dose and increased frequency of ECT and patient-related factors such as advanced age and pre-existing brain diseases are also associated with deterioration of cognition. Later studies have echoed the above findings and have gone on to compare different parameters of ECT and their impact on cognition specifically, concluding that while there is a risk for cognitive impairment with any form of ECT, sine-wave ECT and bilateral electrode placement are more strongly associated with this than brief-pulse ECT and unilateral electrode placement respectively. Patients followed up at one month and six months after ECT were found to perform as well or even better at cognitive tasks compared to their performance before treatment. Another study found that the cognitive adverse effects were short-lived. As a core diagnostic symptom of depression is impairment in the ability to think and concentrate, the effect of ECT on cognition may be confounded by disease factors in these earlier studies, as cognition would improve with the abatement of depressive symptoms. Earlier studies on the effects of ECT on cognition was done on subjects with depression. Prior studies identified that variation in the type of ECT and electrode placements could modify the effects of ECT on cognition, Older sine-wave ECT had a greater adverse impact on memory compared to newer techniques using square wave stimulus, ultrabrief pulse width and unilateral electrode placement. Researchers: please provide the IRB or ethics approval for a study you are currently involved in.The impact of Electroconvulsive Therapy (ECT) on cognition has been the subject of much debate.
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