MMSE during ECT in late-life depression: useful or useless?

Introduction: Electroconvulsive therapy (ECT) is an effective and well-established treatment for late-life depression (LLD). However, there is on ongoing concern about the possible negative impact of ECT on cognition. Our aims were to map the change of Mini-Mental State Examination (MMSE) scores during and after ECT, and to compare the evolution of MMSE-scores in a group of cognitively impaired and unimpaired patients.

Methods: Our study was conducted at two psychiatric hospitals. Patients aged 55 years and older with unipolar depression were included. MMSE was assessed one week prior to ECT, weekly during ECT, one-week, four weeks and six months after the last ECT. Piecewise random Liniear Mixed Models were estimated to obtain trends in cognition.

Results: 110 patients were included. The MMSE-score increases significantly during ECT. During the follow-up period MMSE-score remains stable (F(1,113)=2.40, p=0.12).The group with a low cognitive performance at baseline increases significantly on the MSSE during the course of ECT (t71.8)=7.94, p

Conclusion: ECT does not cause deleterious cognitive effects during and until six months after the index course in patients with LLD, as measured with the MMSE. Even in the event of a baseline cognitive impairment, MMSE-scores improve significantly during ECT and six months after ending it. The presence of pretreatment cognitive impairment should not urge clinicians to withhold ECT in older patients with severe depression. Weighing pros and cons, MMSE may still be useful in screening for cognitive impairment in older patients under circumstances where a cognitive screening that is tolerable is required, as an alternative to extensive neuropsychological batteries.