Longitudinal Associations of Electroconvulsive Therapy with Neuropsychiatric Symptoms, Geriatric Syndromes, and Nursing Home Admission and Mortality Rates among Adults with Dementia

电休克治疗与神经精神症状、老年综合征以及成年痴呆症患者入住疗养院和死亡率的纵向关联

• 批准号: 10731345
• 负责人: Taeho Gregory Rhee
• 金额: $ 33.99万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-15 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10731345
• 关键词: Address; Admission activity; Adult; Advisory Committees; Affect; Aggressive behavior; Aging; Agitation; Alzheimer' s disease related dementia; American Psychiatric Association; Antidepressive Agents; Antipsychotic Agents; Behavior Therapy; Bipolar Disorder; Case Series; Case Study; Catatonia; Cessation of life; Clinic; Clinical; Clinical Trials; Cohort Studies; Data; Data Analyses; Dementia; Depressed mood; Development; Effectiveness; Elderly; Electroconvulsive Therapy; Epidemiology; Etiology; Fire - disasters; Future; General Anesthesia; Guidelines; Health; Health Services Research; Home; Hospitals; Incidence; Individual; Intervention; Knowledge; Life; Link; Longitudinal Studies; Longitudinal cohort; Longitudinal cohort study; Maintenance; Medicare; Medicare claim; Mental Depression; Mental disorders; Methods; Modality; Modeling; Morbidity - disease rate; Neurodegenerative Disorders; Nursing Homes; Outcome; Patient Preferences; Pattern; Population; Prevalence; Public Health; Recommendation; Resources; Risk; Safety; Scalp structure; Schizoaffective Disorders; Seizures; Stimulus; Surveys; Symptoms; Syndrome; Techniques; Testing; Therapeutic; Time; United States Centers for Medicare and Medicaid Services; beneficiary; brain cell; case finding; depressed patient; design; effective therapy; follow-up; frailty; functional decline; functional disability; improved; indexing; innovation; insight; longitudinal analysis; mixed dementia; mortality; multiple data sources; neuropsychiatric symptom; older patient; pharmacologic; population based; psychotic depression; sociodemographics; treatment response; treatment-resistant depression

Project Abstract Alzheimer’s disease and related dementias (ADRD) are the most prevalent, debilitating neuro-degenerative diseases of aging, and current treatments for neuropsychiatric symptoms (NPS) (e.g., agitation, aggression, and depression) of ADRD are mixed. While non-pharmacological behavioral interventions are recommended as first-line treatments for these NPS of ADRD, they require substantial time and resources, and may be less effective for severely agitated, aggressive, or depressed older patients with ADRD. Electroconvulsive therapy (ECT) is an effective and safe treatment for a range of psychiatric disorders, including treatment-resistant depression, schizoaffective disorder, and bipolar disorder. Case series and naturalistic studies support preliminary evidence for the efficacy of ECT to treat severe agitation, aggression, depression, or other NPS in ADRD. To date, associations of ECT with long-term improvement in NPS and geriatric syndromes (e.g., functional declines and frailty), as well as with hospital and nursing home admission rates and all-cause mortality rates are largely unexplored. The proposed nationwide cohort study explicitly addresses these knowledge gaps. Using the Centers for Medicare and Medicaid Services’ 2016-2019 Medicare claims data (Parts A, B, and D) linked with multiple data sources (e.g., Home Health Outcome and Assessment Information Set, Medicare Current Beneficiary Survey, and National Death Index), this proposed study features the following specific aims: 1) to examine incidence and prevalence rates of ECT use and socio-demographic and clinical factors associated with ECT use; 2) to investigate longitudinal associations of ECT with NPS and geriatric syndromes; and 3) to examine differential risks of hospital or nursing home admission rates and all-cause mortality rates by ECT use in older adults with ADRD. Longitudinal data analyses, such as generalized linear mixed modeling and competing-risk regression methods, will be used for Aims 2 and 3. In this nationwide cohort study, we will employ propensity-score matching and instrumental variable techniques to adjust for both observed and unobserved confounders. Intent-to-treat and as-treated analyses will also be conducted. Earlier studies support that ECT is associated with improvement in NPS of ADRD and our analyses show that ECT use with presence of both depression and ADRD was associated with a lower likelihood of all-cause mortality rates; we thus hypothesize that ECT may also be protective against geriatric syndromes. This is the first nationwide, longitudinal cohort study investigating the long-term effectiveness and safety of ECT in adults with ADRD. The proposed study is innovative since it will provide a better understanding of ECT use and its association with NPS, geriatric syndromes, and other health outcomes. Findings from this study will inform clinical guidance on ECT use in older adults with ADRD.

项目摘要 阿尔茨海默病和相关痴呆(ADRD)是最常见的、使人衰弱的神经退行性疾病 老年性疾病，以及神经精神症状(NPS)的当前治疗方法(例如，激越、攻击、 和抑郁症)的ADRD是混合的。而非药理学行为干预是推荐的 作为ADRD这些NPS的一线治疗，它们需要大量的时间和资源，而且可能更少 对患有ADRD的严重烦躁、攻击性或抑郁的老年患者有效。 电休克疗法(ECT)是一种有效而安全的治疗一系列精神疾病的方法， 包括难治性抑郁症、分裂情感障碍和双相情感障碍。案例系列和 自然主义研究支持ECT治疗严重激越、攻击性、 抑郁，或ADRD中的其他NPS。迄今为止，ECT与NPS和NPS的长期改善之间的关联 老年综合征(例如，功能衰退和虚弱)以及住院和疗养院入院 死亡率和全因死亡率在很大程度上是未知的。建议的全国队列研究明确 解决这些知识差距。 使用联邦医疗保险和医疗补助服务中心2016-2019年的联邦医疗保险索赔数据(A、B和 D)与多个数据源链接(例如，家庭健康结果和评估信息集、医疗保险 当前受益人调查和国家死亡指数)，这项拟议的研究具有以下具体特点 目的：1)检查使用ECT的发生率和流行率以及社会人口和临床因素 与ECT使用相关；2)研究ECT与NPS和老年综合征的纵向关联； 以及3)检查住院或疗养院入院率和全因死亡率的不同风险 在患有ADRD的老年人中使用ECT。纵向数据分析，如广义线性混合建模 和竞争风险回归方法，将用于目标2和3。在这项全国性的队列研究中，我们将 使用倾向-分数匹配和工具变量技术来调整观察和 未被察觉的混杂因素。还将进行意向治疗分析和AS治疗分析。早期的研究支持 ECT与ADRD NPS的改善有关，我们的分析表明，ECT与在场一起使用 抑郁症和ADRD与全因死亡率的可能性较低有关；我们因此 假设ECT也可能对老年综合征有保护作用。 这是第一项全国性的纵向队列研究，调查了阿司匹林的长期有效性和安全性 成人ADRD患者的ECT治疗。拟议的研究是创新的，因为它将提供对ECT的更好的理解 使用及其与NPS、老年综合征和其他健康结果的关联。这项研究的发现将 告知患有ADRD的老年人使用ECT的临床指南。