ECCA's Turkish Validity and Reliability Study and Comparison With Other Cognitive Assessment Tests

Plain-language summary

Electroconvulsive therapy (ECT) is one of the oldest biological treatment methods used in psychiatry, based on inducing widespread seizures in the brain with externally applied controlled electrical currents. It was first applied in 1938 by Italian physician Ugo Cerletti and his assistant Lucio Bini. A 1974 report by the American Psychiatric Association stated that ECT was effective in treating depression, mania, and refractory schizophrenia, and it is still used today as an effective and safe method, particularly in the treatment of severe major depression, catatonia, schizophrenia, and mania. Although the exact mechanism of action of ECT is not fully understood, it is suggested that it increases brain receptor sensitivity, accelerates serotonin and dopamine metabolism, activates monoaminergic systems, regulates the circadian rhythm, and provides synchronization between brain hemispheres. In addition, it has been shown to affect neurotransmitter levels, neuroendocrine responses, and neurogenesis processes. Anterograde and retrograde amnesia are among the cognitive side effects that can be seen in the subacute phase of ECT. While anterograde amnesia usually resolves within a few months after treatment, retrograde amnesia can be permanent in some cases. Therefore, assessment of cognitive function before, during, and after ECT is recommended. In clinical practice, the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Test (MMSE) are frequently used for cognitive assessment. However, these scales were not developed to assess ECT-specific cognitive effects and may be limited in detecting retrograde memory loss, autobiographical memory impairments, and subjective memory complaints. Therefore, there is a need for more sensitive tools that can assess ECT-specific cognitive side effects. The Electroconvulsive Cognitive Assessment Test (ECCA), developed for this purpose by Adriana P. Hermida and colleagues from the Department of Psychiatry and Behavioral Sciences at Emory University in Atlanta, is a structured assessment tool consisting of 30 items. The test; The ECCA assesses five cognitive domains: subjective memory, caregiver-assessed memory, attention, autobiographical memory, and delayed verbal recall. A study in the UK compared the ECCA with the MoCA and showed that the ECCA may be more sensitive in assessing cognitive function in individuals undergoing ECT. Similarly, a study in China reported that the ECCA was more sensitive than the MMSE and MoCA in assessing cognitive changes in patients with major depressive disorder after ECT. In conclusion, the limitations of current tools in assessing cognitive function during ECT necessitate the development of ECT-specific measurement tools. In this context, the ECCA is considered an important tool for clinical decision-making and post-treatment cognitive monitoring. Scales are measurement tools used to classify and rate the characteristics to be measured. Scale adaptation studies save time compared to developing a new scale and allow the use of common data collection tools in different cultures. Therefore, conducting validity and reliability studies of tests is of great scientific importance. To conduct a validity and reliability study of the ECCA test in Turkey, the necessary permission was obtained from the test developer, Adriana Hermida. During the translation process, the test was translated from English to Turkish by five independent individuals, and then back-translated by five different individuals. The translations were compared to ensure consistency, and the process was also verified by a sworn translator.

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