Development and Validation of Brief Cognitive tool for Patients Receiving ECT

ECT Task Group

Adriana Hermida, MDDirector, Geriatric Psychiatry Fellowship

Department of Psychiatry and Behavioral ScienceEmory University School of Medicine

NNDC ECT Task Group

Task Group

Mustafa Husain, MD (Co-Chair)

Richard Weiner, MD, PhD (Co-Chair)

James Beeghly, MD

David Casey, MD

Andrew Francis, MD

Adriana Hermida, MD Sarah H. Lisanby, MD

Daniel Maixner, MD

Kevin Reeves, MD

Irving M. Reti, MD

Nelson Rodriguez, MD

Shirlene M. Sampson, MD

Stephen Seiner, MD

Salih Selek, MD

Neurocognitive sub-group:

Richard Weiner, MD, PhD

Mustafa Husain, MD

Irving Reti, MD

Daniel Maixner, MD

Shawn McClintock, PhD

Adriana Hermida, MD

Emory Group

Felicia Goldstein, PhD

David Loring, PhD

Limin Peng, PhD

Zixun Ye, MSPH

Susan Henderson, NP

Patricio Riva-Posse, MD William McDonald, MD

Adriana Hermida, MD

NNDC Collaborators

ECCA Group of Collaborators

Richard Weiner, MD, PhD

Mustafa Husain, MD

Irving Reti, MD

Daniel Maixner, MD

Shawn McClintock, PhD

International Collaborators

Aida de Arriba-Arnaú, MD

Mikel Urretavizcaya, MD, PhD

JM Mechón, MD

V. Soria MD

NNDC Task Group Response

• FDA considers ECT machine as Class III (high risk)• ECT devices were grandfathered (pre-market notification)

In 2009, the Government Accountability Office recommended that the FDA require that all such “grandfathered” devices be either reclassified into Class I or Class II (intermediate-risk) or undergo premarket approval

In Jan 2011, FDA Neurological Devices Advisory Panel met to discuss their assessment of the evidence regarding effectiveness and safety of ECT.

Weiner R, lisanby SH, Husain MM, Morales OG, Maixner DF, Hall SE, Beeghly J, Greeden JF; National Network of Depression Centers. Electroconvulsive therapy device classification: response to FDA advisory panel hearing and recommendations. J Clin Psychiatry. 2013 Jan;74(1):38-42.

FDA Classification

Effectiveness on acute beneficial response was supported but a major focus of the FDA was on memory

dysfunction.

Early detection of emerging cognitive side effects is extremely important.

Adjustment of treatment approach can be made in order to minimize severe long term memory problems.

Introduction

1 Personal Memory Questionnaire (PMQ)

7 CUAMI Columbia University Autobiographical Memory Inventory

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2 Squire Subjective Memory Questionnaire (SSMQ)

3 Autobiographical Memory Inventory (AMI)

4 ECT Retrograde Amnesia and Perception Scale (ERAPS)

5 The Personal and Impersonal Memory Test (PIMT–P)

6 Goldberg-Barnett Remote Memory Questionnaire

Memory Tests in ECT

MoCA and MMSE

Nasreddine ZS, Phillips NA, Bedirian V, et al 2005. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 53:695–699Folstein MF, Folstein SE, McHugh PR. 1975. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 12:189–198.

Current Issues

Current Issues

The ECT field is in need of a short, easy to administer, stand-alone, sensitive tool.

Specific to the ECT cognitive domains.

Development of BriefCognitive Tool

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ECCA Electroconvulsive Cognitive Assessment

Short tool specific for ECT.

Assessment of: subjective memory, autobiographical memory, attention, recall.

Quick and easy to administer (4 to 6 min).

To be done before the first ECT, prior to the 6th ECTs, at the end (1 to 3 weeks after finishing the acute course).

The goal is not to replace neuropsychological testing, but to be used instead of the MoCA and MMSE.

It could be done over the phone

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Electroconvulsive Cognitive Assessment

Short test specific for ECT.

Assessment of: subjective memory, autobiographical memory, attention, recall.

Quick and easy to administer (4 to 6 min).

To be done prior to ECT, after 4 or 6 ECTs, at the end of the acute course and if possible, 1 to 3 weeks after finishing the acute course.

The goal is not to replace neuropsychological testing, but to be used instead of the MOCA and MMSE.

Enrolled

DepressedNo ECT

41 30.1%

Depressed with ECT

55 40.1%

Total

136 100%

NormalControl

40 29.4%

Analysis and Results

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ECCA Domain Analysis

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ECCA Spanish version preliminary data

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Multisite collaboration

Enrolled 14 depressed patients receiving ECTComparing ECCA with MMSE

Enrolled 9 subjects, comparing ECCA with neuropsych testing

Enrolled 25 - 3 groups

International collaboration

Small grant

ECT task Group – Impacting Patient Care

J Psychiatr Pract. 22(6):484-489, 2016.

ECT task Group – Exploring New Projects

Our data support that the ECCA may be a helpful tool to assess cognitive changes associated with ECT

ECCA could alert the clinician during the acute treatment course.

It is helpful to add collateral information when assessing the cognitive SE of ECT

Further research is warranted to determine the psychometric properties of the ECCA

Conclusions

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WE CAN COLLABORATE !

Emory Group

Felicia Goldstein, PhD

David Loring, PhD

Limin Peng, PhD

Zixun Ye, MSPH

Susan Henderson, NP

Patricio Riva-Posse, MD William McDonald, MD

Adriana Hermida, MD

NNDC Collaborators

ECCA Group of Collaborators

Richard Weiner, MD, PhD

Mustafa Husain, MD

Irving Reti, MD

Daniel Maixner, MD

Shawn McClintock, PhD

International Collaborators

Aida de Arriba-Arnaú, MD

Mikel Urretavizcaya, MD, PhD

JM Mechón, MD

V. Soria MD

NNDC ECT Task Group

Task Group

Mustafa Husain, MD (Co-Chair)

Richard Weiner, MD, PhD (Co-Chair)

James Beeghly, MD

David Casey, MD

Andrew Francis, MD

Adriana Hermida, MD Sarah H. Lisanby, MD

Daniel Maixner, MD

Kevin Reeves, MD

Irving M. Reti, MD

Nelson Rodriguez, MD

Shirlene M. Sampson, MD

Stephen Seiner, MD

Salih Selek, MD