Long-term dementia risk following electroconvulsive therapy: A GRADE-assessed systematic review and meta-analysis

Electroconvulsive therapy (ECT) is one of the most effective options for severe psychiatric disorders. However, it is often underutilized due to stigma and fear of cognitive side effects. This is the first systematic review and meta-analysis synthesizing the currently available evidence regarding ECT exposure and dementia risk.

We included observational studies assessing the risk of developing dementia after ECT exposure or its incidence among ECT-treated patients to July 2025. Adjusted hazard ratios (HR) were pooled using a random-effects model.

Six observational cohort studies encompassing 286,995 patients, predominantly with affective disorders, were included. 9124 of the patients were exposed to ECT while 277,871 patients were not treated with ECT. Follow-up durations ranged from a median of 4.9-16.9 years, and the weighted mean baseline age was ∼51 years. Meta-analysis revealed no statistically significant association between ECT exposure and the overall risk of dementia (HR = 0.98, 95 %CI [0.79, 1.21], P = 0.83, I² = 67.1 %, very low certainty). Sensitivity analysis showed a marginally lower risk after excluding one study (HR = 0.87, P = 0.045). In older adults (>50 years; 112,842 patients), ECT was associated with a significantly lower risk of dementia (HR = 0.78, 95 %CI [0.69, 0.88], P < 0.001, I²= 0 %, moderate certainty).

The study provides preliminary insights on the long-term cognitive safety of ECT. ECT was not associated with increased risk of dementia in patients with affective disorders and was associated with lower risk among older adults. More studies are needed to confirm our results, particularly with proper adjustment for potential confounders.