What is the Effect of ECT on Cognitive Functioning?

Research Paper Title

Transient Cognitive Impairment and White Matter Hyperintensities in Severely Depressed Older Patients Treated With Electroconvulsive Therapy.

Background

Although electroconvulsive therapy (ECT) is a safe and effective treatment for patients with severe late life depression (LLD), transient cognitive impairment can be a reason to discontinue the treatment. The aim of the current study was to evaluate the association between structural brain characteristics and general cognitive function during and after ECT.

Methods

A total of 80 patients with LLD from the prospective naturalistic follow-up Mood Disorders in Elderly treated with Electroconvulsive Therapy study were examined. Magnetic resonance imaging scans were acquired before ECT. Overall brain morphology (white and grey matter) was evaluated using visual rating scales. Cognitive functioning before, during, and after ECT was measured using the Mini Mental State Examination (MMSE). A linear mixed-model analysis was performed to analyse the association between structural brain alterations and cognitive functioning over time.

Results

Patients with moderate to severe white matter hyperintensities (WMH) showed significantly lower MMSE scores than patients without severe WMH (F(1,75.54) = 5.42, p = 0.02) before, during, and post-ECT, however their trajectory of cognitive functioning was similar as no time × WMH interaction effect was observed (F(4,65.85) = 1.9, p = 0.25). Transient cognitive impairment was not associated with medial temporal or global cortical atrophy (MTA, GCA).

Conclusions

All patients showed a significant drop in cognitive functioning during ECT, which however recovered above baseline levels post-ECT and remained stable until at least 6 months post-ECT, independently of severity of WMH, GCA, or MTA. Therefore, clinicians should not be reluctant to start or continue ECT in patients with severe structural brain alterations.

Reference

Wagenmakers, M.J., Vansteelandt, K., van Exel, E., Postuma, R., Schouws, S.N.T.M., Obbels, J., Rhebergen, D., Bouckaert, F., Stek., M.L., Barkhof, F., Beekman, A.T.F., Veltman, D.J., Sienaert, P., Dols, A. & Oudega, M.L. (2021) Transient Cognitive Impairment and White Matter Hyperintensities in Severely Depressed Older Patients Treated With Electroconvulsive Therapy. The American Journal of Geriatric Psychiatry. S1064-7481(20)30597-2. doi: 10.1016/j.jagp.2020.12.028. Online ahead of print.

Is the PROMIS® v2.0 Cognitive Function Scale a Reliable Measure of Subjective Cognitive Functioning?

Research Paper Title

Normative Reference Values, Reliability, and Item-Level Symptom Endorsement for the PROMIS® v2.0 Cognitive Function-Short Forms 4a, 6a and 8a.

Background

Reliable, valid, and precise measures of perceived cognitive functioning are useful in clinical practice and research. The researchers present normative data, internal consistency statistics, item-level symptom endorsement, and the base rates of symptoms endorsed for the PROMIS® v2.0 Cognitive Function-Short Forms.

Methods

The four-, six -, and eight-item short form of the PROMIS® v2.0 Cognitive Function scale assess subjective cognitive functioning. The researchers stratified the normative sample from the US general population (n = 1,009; 51.1% women) by gender, education, health status, self-reported history of a depression or anxiety diagnosis, and recent mental health symptoms (i.e. feeling anxious or depressed in the past week) and examined cognitive symptom reporting.

Results

Internal consistency was measured using Cronbach’s alpha and ranged from .85 to .95 for all three forms, across all groups. Mann-Whitney U test comparisons showed that individuals with past or present mental health difficulties scored significantly lower (i.e., worse perceived cognitive functioning) on the self-report questionnaires, particularly the eight-item form (history of depression, men: p < .001, Cohen’s d = 1.07; women: p < .001, d = .99; history of anxiety, men: p < .001, d = 1.06; women: p < .001, d = .98; and current mental health symptoms, men: p < .001, d = 1.38; women: p < .001, d = 1.19).

Conclusions

All three short forms of the PROMIS® v2.0 Cognitive Function scale had strong internal consistency reliability, supporting its use as a reliable measure of subjective cognitive functioning. The subgroup differences in perceived cognitive functioning supported the relationship between emotional and cognitive well-being. This study is the first to present normative values and base rates for several community-dwelling subgroups, allowing for precise interpretation of these measures in clinical practice and research.

Reference

Iverson, G.L., Marsh, J.M., Connors, E.J. & Terry, D.P. (2021) Normative Reference Values, Reliability, and Item-Level Symptom Endorsement for the PROMIS® v2.0 Cognitive Function-Short Forms 4a, 6a and 8a. Archives of Clinical Neuropsychology. doi: 10.1093/arclin/acaa128. Online ahead of print.

Emotional Information Processing & Assessment of Cognitive Functions in Social Anxiety Disorder

Research Paper Title

Emotional Information Processing and Assessment of Cognitive Functions in Social Anxiety Disorder: An Event-Related Potential Study.

Background

The aim of the study was to determine deficits in cognitive areas, including social cognition such as emotion recognition capacity, theory of mind, and electrophysiological alterations in patients with social anxiety disorder (SAD) and to identify their effects on clinical severity of SAD.

Methods

Enrolled in the study were 26 patients diagnosed with SAD and 26 healthy volunteers. They were administered the Liebowitz Social Anxiety Scale (LSAS), Reading Mind in the Eyes Test (RMET), and Cambridge Neuropsychological Test Automated Battery. EEG monitoring was performed for electrophsiologic investigation.

Results

In the patient group, total reading the mind scores were lower (P = .027) while P300 latencies and emotion recognition latency during the Emotion Recognition Task (ERT) were longer (P = .038 and P = .012, respectively). The false alarm scores in the Rapid Visual Information Processing Task (RVP) were higher in the patient group (P = .038).

In a model created using multivariate linear regression analysis, an effect of ERT and RVP scores on LSAS scores was found.

Conclusions

The researches suggest the results of the study confirm that particularly impairment of cognitive functions such as sustained attention and emotion recognition may seriously affect the clinical presentation negatively. P300 latency in the parietal region may has the potential to be a biological marker that can be used in monitoring treatment.

Reference

Tetik, D., Gica, S., Bestepe, E.E., Buyukavsar, A. & Gulec, H. (2020) Emotional Information Processing and Assessment of Cognitive Functions in Social Anxiety Disorder: An Event-Related Potential Study. Emotional Information Processing and Assessment of Cognitive Functions in Social Anxiety Disorder: An Event-Related Potential Study. Clinical EEG and Neuroscience. doi: 10.1177/1550059420981506. Online ahead of print.

Linking Brain Imagery, Brain Tumours, and Cognitive & Mental Disorders in Adults

Research Paper Title

Brain tumours, cognitive and mental disorders in adults.

Background

Cognitive and mental disorders are observed in 15-20% of brain tumours, and can be the first symptoms.

The severity of cognitive deficits varies from attention and reasoning disorders to major syndromes such as delirium, amnesic syndrome or dementia.

Mental disorders range from apathy, irritability to major depressive or psychotic symptoms.

Cognitive and mental disorders are related to many factors including the localisation and nature of the tumour, peritumoral and remote changes, and personal susceptibility.

The diagnosis of brain tumour is presently made by brain imagery, but the difficulty remains to determine when imagery is to be used in cognitive or mental disorders.

Reference

Derouesne, C. (2020) Brain tumors, cognitive and mental disorders in adults. Geriatrie et Psychologie Neuropsychiatrie du Vieillissement. 13(2), pp.187-194. doi: 10.1684/pnv.2015.0533.

Can Participation in HIIT Improve Cognitive Function & Mental Health in Children & Adolescents?

Research Paper Title

Review of High-Intensity Interval Training for Cognitive and Mental Health in Youth.

Background

High-intensity interval training (HIIT) has emerged as a time-efficient strategy to improve children’s and adolescents’ health-related fitness in comparison to traditional training methods. However, little is known regarding the effects on cognitive function and mental health.

Therefore, the aim of this systematic review was to evaluate the effect of HIIT on cognitive function (basic information processing, executive function) and mental health (well-being, ill-being) outcomes for children and adolescents.

Methods

A systematic search was conducted, and studies were eligible if they:

  1. Included a HIIT protocol;
  2. Examined cognitive function or mental health outcomes; and
  3. Examined children or adolescents (5-18 years) old.

Separate meta-analyses were conducted for acute and chronic studies, with potential moderators (i.e. study duration, risk of bias, participant age, cognitive demand, and study population) also explored.

Results

A total of 22 studies were included in the review. In acute studies, small to moderate effects were found for executive function (standardised mean difference [SMD], 0.50, 95% confidence interval [CI], 0.03-0.98; P = 0.038) and affect (SMD, 0.33; 95% CI, 0.05-0.62; P = 0.020), respectively. For chronic studies, small significant effects were found for executive function (SMD, 0.31; 95% CI, 0.15-0.76, P < 0.001), well-being (SMD, 0.22; 95% CI, 0.02-0.41; P = 0.029), and ill-being (SMD, -0.35; 95% CI, -0.68 to -0.03; P = 0.035).

Conclusions

The review provides preliminary review evidence suggesting that participation in HIIT can improve cognitive function and mental health in children and adolescents.

Because of the small number of studies and large heterogeneity, more high-quality research is needed to confirm these findings.

Reference

Leahy, A.A., Mavilidi, M.F., Smith, J.J., Hillman, C.H., Eather, N., Barker, D. & Lubans, D.R. (2020) Review of High-Intensity Interval Training for Cognitive and Mental Health in Youth.

Is Protein Intake Associated with Cognitive Functioning in Individuals with Psychiatric Disorders?

Research Paper Title

Protein intake is associated with cognitive functioning in individuals with psychiatric disorders.

Background

Schizophrenia and bipolar disorder are associated with reduced cognitive functioning which contributes to problems in day-to-day functioning and social outcomes.

A paucity of research exists relating dietary factors to cognitive functioning in serious mental illnesses, and results are inconsistent.

The study aims to describe the nutritional intake of persons with schizophrenia and those with a recent episode of acute mania and to determine relationships between the intake of protein and other nutrients on cognitive functioning in the psychiatric sample.

Methods

Persons with schizophrenia and those with acute mania were assessed using a 24-h dietary recall tool to determine their intakes of protein and other nutrients.

They were also assessed with a test battery measuring different domains of cognitive functioning. Results indicate that lower amounts of dietary protein intake were associated with reduced cognitive functioning independent of demographic and clinical factors.

Results

The association was particularly evident in measures of immediate memory and language.

There were not associations between cognitive functioning and other nutritional variables, including total energy, gluten, casein, saturated fat, or sugar intakes.

Conclusions

The impact of dietary interventions, including protein intake, on improving cognitive functioning in individuals with psychiatric disorders warrants further investigation.

Reference

Dickerson, F., Gennusa, J.V. 3rd, Stallings, C., Origoni, A., Katsafanas, E., Sweeney, K., Campbell, W.W. & Yolken, R. (2019) Protein intake is associated with cognitive functioning in individuals with psychiatric disorders. Psychiatry Research. doi: 10.1016/j.psychres.2019.112700. [Epub ahead of print].