Development and validation of revised battery for ECT-related cognitive deficits (B4ECT ReCoDe)

The B4ECT ReCode Battery was developed a decade ago to evaluate cognitive impairments associated with electroconvulsive therapy (ECT). This study aimed to develop and validate a revised version of the Battery.

We reviewed literature to identify cognitive domains relevant to ECT. Focus group discussions highlighted limitations of the original battery. We prepared a draft version, which was validated through expert ratings using Delphi method. We further validated battery by administering it to 60 participants undergoing bifrontal brief-pulse ECT at baseline, after third and sixth ECT sessions.

The revised battery included letter and category fluency as new cognitive domains, while omitting the processing speed (Digit Symbol Substitution) and working memory (Letter Number Sequencing). CVR (0.60-1.00) for all parameters and CVI (> 0.8) were adequate for all tests. Assessment of participants revealed a significant decline in category fluency (p = 0.001), letter fluency (p < 0.0001), subjective memory (patient, p < 0.0001; caregiver, p = 0.002), and autobiographical memory scores (p < 0.0001) over six ECT sessions. The completion rate was 91.67%. The recruited and excluded participants were comparable in sociodemographics, diagnosis, and ECT indications, supporting generalizability. Inter-rater reliability for ordinal variables (Cohen's kappa: 0.794 - 0.923) and intraclass correlation coefficient for continuous variables (0.899-0.925) were good.

The revised B4ECT ReCoDe exhibits reasonable content validity, inter-rater reliability and feasibility. Its findings align with established patterns of cognitive effects observed in ECT. This preliminary psychometric validity serves as a solid foundation for further exploration in clinical and research settings.