A rapid bedside inventory for post-electroconvulsive therapy cognition: Derivation and validation of the electroconvulsive therapy-cognition inventory (ECT-CI).
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引用次数: 0
Abstract
Background: Electroconvulsive therapy (ECT) is effective for treatment-resistant major depressive disorder (MDD), but peri-treatment cognitive effects require rapid, accurate bedside assessment. We developed and prospectively validated the Electroconvulsive Therapy-Cognition Inventory (ECT-CI).
Methods: Single-centre, prospective, assessor-masked diagnostic-accuracy/psychometric study including adults with MDD initiating first-course ECT (n = 54; assessed ≤48 h pre-ECT and 7-10 days post-ECT) and age-matched healthy controls (n = 54, single assessment). The reference standard was a DSM-5-TR-anchored, blinded clinical determination of clinically significant cognitive impairment (yes/no) rendered independently by two psychiatrists, who were masked to index-test results.Index tests were ECT-CI (primary) and MoCA (comparator). The primary endpoint was post-ECT ROC AUC; secondary endpoints included pre-post responsiveness, administration time, and inter-rater agreement (Lin's CCC). Prospectively registered (ChiCTR2400094414).
Findings: Among 108 participants, ECT-CI declined from 24.99 to 20.07 after ECT (mean change 4.92; 95 % CI 4.17-5.67), whereas MoCA showed no change. Post-ECT discrimination favoured ECT-CI over MoCA (AUC 0.972 [95 % CI 0.928-1.000] vs 0.852 [0.751-0.953]). The operational ECT-CI cut-off (≤21) yielded sensitivity 0.970 and specificity 0.905; MoCA's optimal cut-off (25.5) yielded sensitivity 0.909 and specificity 0.667. ECT-CI required 5.9 ± 2.1 min versus 10.7 ± 3.9 min for MoCA. Inter-rater reliability for ECT-CI was high (Lin's CCC 0.922; 95 % CI 0.810-0.969).
Interpretation: ECT-CI outperformed MoCA for detecting clinically defined post-ECT cognitive impairment, was more responsive to short-term change, and was briefer to administer. An operational threshold of ≤ 21 supports pragmatic bedside use; external multicentre validation is warranted.
期刊介绍：
The Asian Journal of Psychiatry serves as a comprehensive resource for psychiatrists, mental health clinicians, neurologists, physicians, mental health students, and policymakers. Its goal is to facilitate the exchange of research findings and clinical practices between Asia and the global community. The journal focuses on psychiatric research relevant to Asia, covering preclinical, clinical, service system, and policy development topics. It also highlights the socio-cultural diversity of the region in relation to mental health.
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