Comparison of Cognitive Screening Tools Used to Assess Neurocognitive Side Effects of Electroconvulsive Therapy: A Systematic Review.

Abstract

This systematic review identified and critically appraised existing research comparing cognitive screening tools used to assess neurocognitive side effects of electroconvulsive therapy (ECT). A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines and the Synthesis Without Meta-analysis (SWiM) reporting guideline. A protocol was registered with the Open Sciences Network (OSF) registry, and critical appraisal was completed using the Joanna Briggs Institute Critical Appraisal tool for Diagnostic Test Accuracy Studies. Pragmatic criteria were applied to assess relative strengths and weaknesses of the identified cognitive screening tools for application to clinical practice. Nine studies met the inclusion criteria; 2 ECT-specific cognitive screening tools, 2 generalised cognitive screening tools, 4 neurocognitive batteries, and 1 brief memory scale. The ECT-specific cognitive screening tools were the Brief ECT Cognitive Screen (BECS) and the ElectroConvulsive Therapy Cognitive Assessment (ECCA). The Montreal Cognitive Assessment (MoCA) was the most common generalised cognitive screening tool used. The BECS and ECCA scored the highest using our specific pragmatic criteria. Key limitations across the included studies were the lack of a suitable gold standard comparator and inadequate blinding of assessors. There is limited evidence to support the superiority of one cognitive tool over another for assessing neurocognitive side effects associated with ECT. The primary limitations across the current literature base are the lack of a gold standard reference tool and heterogeneity of included populations. There is a need for further research to validate the sensitivity and specificity of tools such as the BECS and ECCA.