Self-evaluation of the cognitive effects of ECT

Abstract

Objectives:

Numerous studies have found that subjective memory improves shortly following ECT using standard self-evaluation questionnaires. These changes covary strongly with mood state while being not associated with objective memory tests or treatment parameters. This study compared patients' evaluations of the cognitive effects of ECT using a novel direct interview about subjective global impact and standard methods.

Methods:

We conducted a prospective, randomized, double-masked trial of the effects of pulse width (0.3 vs. 1.5 ms) and electrode placement (right unilateral vs. bilateral) on patients' evaluations of cognitive outcomes. Subjective evaluations were obtained prior to starting and during the week following the randomized ECT course, using the Cognitive Failures Questionnaire (CFQ), Squire Memory Complaint Questionnaire (SMCQ), and the novel Global Self-Evaluation of Memory (GSE-My). An extensive neuropsychological battery was administered at the same time points.

Results:

CFQ and SMCQ scores improved at postECT relative to preECT. At both time points, these scores were strongly associated with HRSD scores and not with objective deficits or treatment parameters. In contrast, on the GSE-My patients reported a deleterious memory effect after ECT. GSE-My scores were also associated with objective memory loss and treatment technique.

Conclusions:

Characterization of patients' experience of cognitive side effects following ECT differs markedly depending on the assessment method. Direct questioning about global impact revealed more negative views about ECT's impact. These results support the findings of a prospective, naturalistic, observational community study representing together the first reports of concordance between subjective and objective measures of ECT's effects on memory.