Age-related cognitive effects of ECT and ECT-induced mood improvement in depressive patients

This explorative study investigated the interaction between electroconvulsive therapy (ECT) treatment-effect, reduced depression, and neuropsychological outcome in relation to age. Follow-up neuropsychological assessment was conducted with depressive patients treated with ECT. From a potential sample of 45 patients, the neuropsychological measures (pre-ECT, three times post-ECT, up to 12 months) and clinical data from the remaining 21 patients who completed all assessments were evaluated (mean age=56.76; SD=14.12; range, 33-79). ECT resulted in a decrease in the depression scores. A distinct impact of ECT and depression decrease on cognitive domains was found. Depression alleviation was mainly associated with improvement in cognitive domains such as memory, information processing, and executive function. ECT improved cognitive domains such as information processing and perception. Short-term cognitive improvement was greater in older patients but showed an increase similar to that at long-term follow-up in younger patients (<60). Current findings provide evidence that ECT may improve cognitive functioning in nondemented elderly, which has strong clinical relevance concerning the use of ECT.

A model for quality of life measures in patients with dementia: Lawton's next step

The introduction of drugs that are claimed to improve cognitive function and activities of daily living in patients with Alzheimer's disease raises the question of whether these drugs also influence dementia patients' quality of life (QOL). We describe a hierarchic model of QOL of dementia patients, which can guide the development of measurement instruments. After initially discussing broadly QOL research, we focus on two highly important characteristics of the concept, its broadness and subjectivity, against the background of the relevant literature on QOL in dementia. Dementia-specific dimensions and domains are presented. We identify psychological well-being as the core dimension for QOL of patients with dementia.

[Quality of life and dementia. I. Model of assessment of wellbeing in dementia patients]

The introduction of cholinesterase inhibitors to improve the cognitive function and activities of daily living in patients with Alzheimer disease, raises the question whether these drugs also have the potential to improve the quality of life of these patients. In this article a model is presented to measure quality of life in patients with dementia, in which psychological well-being is chosen as the central measure. The presented model might be the starting point to develop instruments to measure quality of life in dementia. After a short introduction concerning the developments in quality of life research, the two most important characteristics of the concept--multidimensionality and subjectivity--are discussed against the background of the relevant literature on dementia. The dementia-specific dimensions--individual characteristics, psychological, social and physical dimension, and environment--and domains are presented, and put in a hierarchical model.

[Quality of life and dementia. II. Selection of a measurement instrument for wellbeing appropriate for the reference model]

Measuring demented patients' 'quality of life' is an important issue in the Netherlands. Due to diminished cognition and other characteristics of dementia, general instruments are not suitable. A conceptual model for quality of life in dementia should guide instrument choice. We used a recently developed model, in which 'well-being' is indicated as the standard for quality of life. Appropriateness of fit in the model is shown of three important instruments developed in the '90s. Eventually, the 'Dementia Quality of Life instrument' (DQoL or D-QoL) of Brod et al., 1999 was selected as exhibiting the best fit. The DQoL measures well-being as a balance of positive and negative aspects. Other instruments consider, for example, either positive or negative aspects or include determinants of well-being, such as the general health condition. In contrast to the other instruments, the DQoL requires only the patient's own opinion. We plan further validation of the DQoL in Dutch demented patients.