The Cortisol Awakening Response as a Biomarker for Cognitive Side-Effects of Electroconvulsive Therapy

Objective: To test whether the cortisol awakening response (CAR) could be a biomarker for cognitive decline during electroconvulsive therapy (ECT). Methods: We studied 50 older patients with depression who were treated with ECT from the MODECT cohort. We used linear regression analyses to examine the association between CAR and cognitive change, assessed by the change in Mini Mental State Examination scores between baseline and 1 week after ECT course. CAR was assessed by the area under the curve of cortisol levels, according to Pruessner's-formula. Associations were adjusted for putative confounders, based on previous literature and availability. Results: We found no significant associations between the CAR and cognitive change during the ECT course in (un)adjusted models. Conclusion: Our results indicate that the CAR is not usable as a biomarker for ECT-induced cognitive decline during ECT course. Further research in cohorts with larger samples is needed. (Am J Geriatr Psychiatry 2023; 31:991-995)