Predictors of cognitive changes in patients with schizophrenia undergoing electroconvulsive therapy.

INTRODUCTION: Previous studies on the effects of electroconvulsive therapy (ECT) on cognition in schizophrenia have been inconclusive. This study aimed to identify factors that may predict cognitive improvement or deterioration in patients with schizophrenia after-ECT. MATERIALS & METHODS: Patients with schizophrenia or schizoaffective disorder with predominantly positive psychotic symptoms, who were treated with ECT at the Institute of Mental Health (IMH), Singapore, between January 2016 and January 2018, were assessed. Montreal Cognitive Assessment (MoCA), Brief Psychiatric Rating Scale (BPRS) and Global Assessment of Function (GAF) were performed before and after ECT. Patients with clinically significant improvement, deterioration or no change in MoCA scores were compared on demographics, concurrent clinical treatment and ECT parameters. RESULTS: Of the 125 patients analysed, 57 (45.6%), 36 (28.8%) and 32 (25.6%) showed improvements, deterioration and no change in cognition respectively. Age and voluntary admission predicted MoCA deterioration. Lower pre-ECT MoCA and female sex predicted MoCA improvement. Patients showed improvements in GAF, BPRS and BPRS subscale scores on average, except for the MoCA deterioration group, who did not show statistically significant improvement in negative symptom scores. Sensitivity analysis showed that nearly half the patients (48.3%) who were initially unable to complete MoCA pre-ECT were able to complete MoCA post-ECT. CONCLUSIONS: The majority of patients with schizophrenia demonstrate improved cognition with ECT. Patients with poor cognition pre-ECT are more likely to see improvement post-ECT. Advanced age may be a risk factor for cognitive deterioration. Finally, improvements in cognition may be associated with improvements in negative symptoms.

Effects of electroconvulsive therapy on cognition and quality of life in schizophrenia.

INTRODUCTION: The effects of electroconvulsive therapy (ECT) on quality of life (QoL), and its relationship with symptom and cognitive change remains unclear. We aim to examine the association of QoL changes with psychiatric symptom and cognitive changes among patients with schizophrenia who underwent ECT. METHODS: This is a retrospective cohort study of 132 patients who received ECT from July 2017 to December 2019. Sociodemographic and clinical characteristics were obtained from medical records. Changes in QoL, psychiatric symptoms and cognition function were examined after 6 sessions of ECT. Generalised linear regression was used to examine the associations of Brief Psychiatric Rating Scale (BPRS) scores and Montreal Cognitive Assessment (MoCA) scores with QoL as measured by EQ-5D scores. RESULTS: The mean (standard error) improvements after ECT were statistically significant for the assessment scales of EQ-5D utility score: 0.77 (0.02) to 0.89 (0.02), P<0.001; EuroQol-5-Dimension (EQ-5D) visual analogue scale score: 66.82 (2.61) to 73.05 (1.93), P=0.012; and EQ-5D subdomain scores. Both improvement in BPRS (adjusted ß coefficient -0.446, 95% confidence interval [CI] -0.840 to -0.052) and MoCA (adjusted ß 12.068, 95% CI 0.865 to 12.271) scores were significantly associated with improvement in EQ-5D utility scores after adjustment for sociodemographic and clinical characteristics. Improvement of BPRS scores (psychiatric symptoms) was significantly associated with improvement of the patients' mental health that was assessed by EQ-5D subdomain scores of pain (adjusted ß coefficient 0.012, 95% CI 0.004 to 0.021) and anxiety (adjusted ß coefficient 0.013, 95% CI 0.002 to 0.024). Improvement of MoCA scores (cognitive function) was significantly associated with patients' physical health as assessed by EQ-5D subdomain score of usual activity (adjusted ß coefficient -0.349, 95% CI -0.607 to -0.09). CONCLUSION: ECT was associated with an overall improvement of QoL among patients with schizophrenia. The improvement of psychiatric symptoms was found to be significantly associated with better mental health while the improvement of cognitive function was associated with better physical health.

Standing Long Jump Performance With an External Focus of Attention Is Improved as a Result of a More Effective Projection Angle.

Investigators have recently demonstrated that standing long jump performance is enhanced when participants focus their attention externally instead of their leg action but found no differences when examining peak force. The purpose of this study was to examine kinetic and kinematic properties associated with the standing long jump that may explain disparities between an internal and external focus of attention. It was hypothesized that the external focus condition would exhibit greater impulse values and a more optimal projection angle (45°) than the internal condition. Twenty-one participants each performed 5 total jumps: 1 baseline jump, in which no focus instructions were given, followed by 4 remaining jumps in which either internal or external focus instructions were introduced in a counter-balanced manner. Analysis of variance revealed that the external condition jumped significantly farther than the internal and baseline conditions. Analyses of kinetic measures (i.e., peak force and impulse) revealed no significant differences among conditions. However, there was a significant difference between the internal and baseline conditions compared with the external condition with respect to projection angle. Specifically, participants in the external focus condition exhibited an average projection angle of 45.7°, compared with the internal (49.5°) and baseline (49.0°) conditions. Therefore, the observed difference in jump distance among conditions can be explained by the external condition producing a more optimal projection angle. The results of this study partially support the constrained action hypothesis.

Individual and Area Level Socioeconomic Status and Its Association with Cognitive Function and Cognitive Impairment (Low MMSE) among Community-Dwelling Elderly in Singapore.

BACKGROUND/AIMS: Neighborhood socioeconomic status (SES) can affect cognitive function. We assessed cognitive function and cognitive impairment among community-dwelling elderly in a multi-ethnic urban low-SES Asian neighborhood and compared them with a higher-SES neighborhood. METHODS: The study population involved all residents aged ≥60 years in two housing estates comprising owner-occupied housing (higher SES) and rental flats (low SES) in Singapore in 2012. Cognitive impairment was defined as <24 on the Mini Mental State Examination. Demographic/clinical details were collected via questionnaire. Multilevel linear regression was used to evaluate factors associated with cognitive function, while multilevel logistic regression determined predictors of cognitive impairment. RESULTS: Participation was 61.4% (558/909). Cognitive impairment was found in 26.2% (104/397) of residents in the low-SES community and in 16.1% (26/161) of residents in the higher-SES community. After adjusting for other sociodemographic variables, living in a low-SES community was independently associated with poorer cognitive function (ß = -1.41, SD = 0.58, p < 0.01) and cognitive impairment (adjusted odds ratio 5.13, 95% CI 1.98-13.34). Among cognitively impaired elderly in the low-SES community, 96.2% (100/104) were newly detected. CONCLUSION: Living in a low-SES community is independently associated with cognitive impairment in an urban Asian society.