Electroconvulsive therapy (ECT), albeit highly effective in treating depression, is frequently associated with
cognitive impairment, either temporary or more persistent. Especially in older patients, who generally respond even better, serious
cognitive impairment during the course of ECT may lead to premature termination of ECT. Treatment of this
cognitive impairment is of utmost importance. In this case series report, we present the effect of
rivastigmine, an
acetylcholinesterase inhibitor, on
cognitive impairment in three older, severely depressed patients during or after a course of ECT. An improvement of cognitive functioning, in particular a decline of confusional symptoms, was observed in two patients with structural brain alterations associated with aging. In the other patient, who suffered primarily from
amnesia, no effect of
rivastigmine was observed. These preliminary results emphasize the need for detailed profiling of
cognitive impairment when developing a research design to study the potential benefits of
rivastigmine in the prevention or treatment of
cognitive impairment in severely depressed patients treated with ECT.