Development and Validation of Brief Cognitive tool for Patients Receiving ECT ECT Task Group

Transcription

1 Development and Validation of Brief Cognitive tool for Patients Receiving ECT ECT Task Group Adriana Hermida, MD Director, Geriatric Psychiatry Fellowship Department of Psychiatry and Behavioral Science Emory University School of Medicine

2 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

3 ECCA Group of Collaborators 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 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

4 NNDC Task Group Response

5 FDA Classification 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. Effectiveness on acute beneficial response was supported but a major focus of the FDA was on memory dysfunction. 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 Jan;74(1):38-42.

6 Introduction 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.

7 Memory Tests in ECT 1 Personal Memory Questionnaire (PMQ) 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 7 CUAMI Columbia University Autobiographical Memory Inventory 7

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

9 Current Issues

10 Current Issues The ECT field is in need of a short, easy to administer, stand-alone, sensitive tool. Specific to the ECT cognitive domains.

11 Development of Brief Cognitive Tool

12 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 12

13 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. 13

14 Enrolled Total % Normal Control Depressed No ECT Depressed with ECT % % %

15 Analysis and Results

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19 ECCA Domain Analysis 19

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22 ECCA Spanish version preliminary data

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24 Multisite collaboration Enrolled 14 depressed patients receiving ECT Comparing ECCA with MMSE Enrolled 9 subjects, comparing ECCA with neuropsych testing Enrolled 25-3 groups International collaboration

25 Small grant

26 ECT task Group Impacting Patient Care J Psychiatr Pract. 22(6): , 2016.

27 ECT task Group Exploring New Projects

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29 Conclusions 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

30 30 WE CAN COLLABORATE!

31 ECCA Group of Collaborators 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 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

32 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