The significance of white matter hyperintensity, inflammation, and cognition in ECT for geriatric depression

Do white matter hyperintensities (WMH) influence the decision of whether geriatric patients with depression should receive ECT? In the current issue of the AJGP, Angela Carlier and colleagues attempt to answer this question by examining the interactions between WMH, inflammatory biomarkers, and cognition during a course of ECT. Previous work by the authors in this same prospective cohort of older patients with depression demonstrated that both elevated inflammatory biomarkers and severe WMH may predict adverse cognitive effects from ECT; however, the direct interaction between inflammation and WMH has not been examined. 1 Carlier A Rehbergen D Veerhuis R et al. Inflammation and cognitive functioning in depressed older adults treated with electroconvulsive therapy; a prospective cohort study. J Clin Psychiatry. 2021; (82(5):20m13631) Google Scholar ,2 Wagenmakers MJ Vansteelandt K van Exel E et al. Transient cognitive impairment and white matter hyperintensities in severely depressed older patients treated with electroconvulsive therapy. Am J Geriatr Psychiatry. 2021; : 1-12https://doi.org/10.1016/j.jagp.2020.12.028 Google Scholar In the current study, “Inflammation on cognitive functioning after electroconvulsive therapy in older patients with depression with and without white matter hyperintensities,” the authors aim to clarify how ECT use in elderly patients both with and without WMH may relate to inflammatory markers.