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 阿尔茨海默氏病和相关痴呆症 (ADRD) 是最常见的、使人衰弱的神经退行性疾病 衰老疾病以及神经精神症状 (NPS)（例如，激动、攻击性、 ADRD 和抑郁症）的情况是混合的。虽然建议采取非药物行为干预措施 作为 ADRD 的这些 NPS 的一线治疗方法，它们需要大量的时间和资源，而且可能更少 对于严重烦躁、攻击性或抑郁的老年 ADRD 患者有效。 电休克疗法 (ECT) 是治疗一系列精神疾病的有效且安全的方法， 包括难治性抑郁症、分裂情感性障碍和双相情感障碍。案例系列及 自然主义研究支持 ECT 治疗严重躁动、攻击性、 抑郁症或 ADRD 中的其他 NPS。迄今为止，ECT 与 NPS 和 NPS 长期改善的关联 老年综合症（例如功能衰退和虚弱），以及入院和疗养院 死亡率和全因死亡率在很大程度上尚未得到探索。拟议的全国队列研究明确 解决这些知识差距。 使用 Medicare 和 Medicaid 服务中心的 2016-2019 年 Medicare 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 ECT 使用的发生率和流行率以及社会人口统计和临床因素 与 ECT 使用相关； 2) 研究 ECT 与 NPS 和老年综合征的纵向关联； 3) 通过以下方式检查医院或疗养院入院率和全因死亡率的不同风险 ECT 在患有 ADRD 的老年人中的应用。纵向数据分析，例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。在这项全国性队列研究中，我们将 采用倾向得分匹配和工具变量技术来调整观察到的和 未观察到的混杂因素。还将进行意向治疗和治疗分析。早期研究支持 ECT 与 ADRD 的 NPS 改善相关，我们的分析表明 ECT 的使用与存在 抑郁症和 ADRD 的发生率与全因死亡率的可能性较低有关；我们因此 假设 ECT 也可能预防老年综合症。 这是第一个全国范围内的纵向队列研究，调查长期有效性和安全性 患有 ADRD 的成人 ECT。拟议的研究具有创新性，因为它将提供对 ECT 的更好理解 使用及其与 NPS、老年综合征和其他健康结果的关联。这项研究的结果将 为患有 ADRD 的老年人提供 ECT 使用的临床指导。