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

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Revised B4ECT ReCoDe validated via literature review, Delphi method, and testing in 60 bifrontal brief-pulse ECT patients.
Significant decline over six ECT sessions in category fluency, letter fluency, subjective memory (patient and caregiver) and autobiographical memory.
Battery demonstrated adequate content validity, strong inter-rater reliability, 91.67% completion rate and generalisability to clinical ECT populations.

Asian J Psychiatr. 2026 Jun 5;122:105041. doi: 10.1016/j.ajp.2026.105041. Online ahead of print.

ABSTRACT

INTRODUCTION: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

PMID:42263327 | DOI:10.1016/j.ajp.2026.105041

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