The global ECT MRI collaboration: cognitive battery and prospective recommendations

Abstract Background: ECT-mediated cognitive impairment remains prevalent, perpetuates stigma associated with the procedure, and can be dissuasive during the consent process. The Global ECT MRI Collaboration (GEMRIC) has been successful in collecting clinical and neuroimaging data from around the world. Results to date have focused on neuroimaging correlates of treatment response and related covariates. GEMRIC sites have also collected cognitive data, which can be combined with imaging for mega-analyses. Here, we summarize the existing GEMRIC cognitive data as well as recommendations for prospective data collection for future ECT-imaging investigations. Methods: We describe the rationale for the existing cognitive measures for mega-analyses: Trail Making Test Parts A and B, Category and Letter Fluency, and percent recall from verbal declarative memory tests. We provide summary statistics for each time point: pre-, mid-, post-ECT, and follow-up visits. We performed longitudinal data analysis focused on the pre-/post-ECT time with healthy comparison subjects and assessed demographic and ECT parameters associated with cognitive changes. Results: We did not have a main effect for group (HC, RUL/BF/LART, and BT) for any of the cognitive variables. On the Trail Making Test Part A, males had decreased performance (7 seconds) relative to females averaged for site and group. On Trail Making Test Part B, BT subjects with improved depression outcomes demonstrated faster TMT-B test performance relative to RUL/BF/LART and HC groups. Conclusion: We assessed the current GEMRIC cognitive data and acknowledge the limitations associated with this data set. We also provide prospective recommendations for future ECT-imaging investigations with specific emphasis on autobiographical memory tests. Research Category and Technology and Methods Clinical Research: 2. Electroconvulsive Therapy (ECT) Keywords: Electroconvulsive Therapy, Neurocognition, Undesired Effects, Neuropsychology