Invited ReviewsStrategies to Minimize Cognitive Side Effects With ECT Aspects of ECT TechniquePrudic, Joan MD Author Information From the New York State Psychiatric Institute; and Department of Psychiatry, Columbia College of Physicians and Surgeons, Columbia University, New York, NY. Received for publication August 15, 2007; accepted October 18, 2007. Reprints: Joan Prudic, MD, New York State Psychiatric Institute, 1051 Riverside Dr, Unit 126, New York, NY 10032. The Journal of ECT: March 2008 - Volume 24 - Issue 1 - p 46-51 doi: 10.1097/YCT.0b013e31815ef238 Buy Metrics Abstract The adverse cognitive effects of electroconvulsive therapy are important limitations in the use of this treatment that continues to be a significant therapeutic strategy after 7 decades of use. Among the approaches to mitigation of these side effects are considerations involving the prescription and manipulation of the electrical stimulus itself. The impact of the following electrical factors on the cognitive outcomes of electroconvulsive therapy are surveyed: efficiency of the stimulus as expressed in electrical waveform; targeting of the stimulus, the major concept underlying electrode placement; stimulus dosing; and frequency and number of treatments. The current state of development of knowledge in these areas is summarized, and methods to achieve the best cognitive outcomes without sacrificing clinical efficacy are discussed. Future trends in the further optimization of the electrical stimulus are briefly mentioned. © 2008 Lippincott Williams & Wilkins, Inc.