Cortisol levels predict cognitive impairment induced by electroconvulsive therapy

Background: Elevated glucocorticoids may increase the vulnerability of the brain to the adverse effects of repeated seizures. This study tested the hy pothesis that higher ambient cortisol levels would predict increased cognit ive impairment in depressed patients subsequent to receiving electroconvuls ive therapy (ECT) for major depression. Methods: Sixteen subjects provided three samples of saliva the day before r eceiving unilateral nondominant ECT. Measures of mood, global cognitive fun ctioning, attention, executive function, verbal and visuospatial memory, an d visuospatial processing speed were obtained I day before the first ECT an d I day af-ter the sixth ECT treatment. The relationship between basal sali vary cortisol obtained before the first ECT treatment and the change score of each cognitive measure after the sixth ECT treatment was examined and te sted with Pearson correlation coefficients. Results: Electroconvulsive therapy treatments delivered over 2 weeks result ed in a significant improvement in mood and a decline in most measures of c ognitive performance. Elevated basal cortisol was associated with a greater decline in performance of executive function, visuospatial processing spee d, and verbal memory. Conclusions: Although this study is limited by the small number of subjects and the high number of comparisons, all significant correlations were cons istent with the hypothesis that elevated cortisol predicts a greater degree of ECT-induced cognitive impairment. Biol Psychiatry 2001;50: 331-336 (C) 2001 Society of Biological Psychiatry.