Epidemiology and Clinical Outcomes of Electroconvulsive Therapy Use in Nursing Home Residents with Dementia

项目摘要 阿尔茨海默病和相关痴呆（ADRD）是最普遍的、使人衰弱的神经退行性疾病， 衰老的疾病，以及目前对神经精神症状（CNS）的治疗（例如，激动，攻击， 抑郁症（ADRD）是混合的。虽然非药物行为干预是推荐的， 作为这些ADRD的一线治疗，它们需要大量的时间和资源， 对严重激动、攻击性或抑郁的老年ADRD患者有效。 电休克治疗（ECT）是一种有效和安全的治疗精神疾病的范围， 包括难治性抑郁症、情感障碍和双相情感障碍。病例系列和 无对照的自然主义研究支持ECT治疗严重激越有效的初步证据， 抑郁症或其他ADRD疾病。ECT与脑卒中和老年病长期改善的关系 综合征（例如，功能性残疾和虚弱），以及老年人的全因死亡率 与ADRD在养老院设置在很大程度上是未知的。拟议的全国性队列研究明确 填补了这些知识空白。 使用医疗保险和医疗补助服务中心的2018-2020年医疗保险索赔数据（A、B和 D）链接到多个数据源（例如，最小数据集[MDS]和国家死亡指数[NDI]），这 本研究的目的如下：1）调查ECT使用的发生率和流行率 与ECT使用相关的社会人口统计学和临床因素; 2）调查纵向关联 的ECT与老年综合征;和3）检查全因死亡率的差异风险， 在养老院环境中患有ADRD的老年人中使用ECT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 这项全国性的队列研究，我们将采用倾向评分匹配和工具变量技术， 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实际治疗分析。 进行。早期的研究支持ECT与ADRD的预后改善有关，我们的分析 显示在抑郁和ADRD同时存在情况下使用ECT与所有- 导致死亡率;因此，我们假设ECT也可能对老年综合征有保护作用。 这是第一个全国性的队列研究，调查ECT的长期有效性和安全性， 老年人与ADRD在疗养院设置。建议的研究是创新的，因为它将提供一个更好的 了解ECT的使用及其与NPS、老年综合征和其他相关健康的关联 结果。这项研究的结果将为老年ADRD患者使用ECT提供临床指导， 养老院设置。

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 uncontrolled naturalistic studies support preliminary evidence for the efficacy of ECT to treat severe agitation, depression, or other NPS in ADRD. Associations of ECT with long-term improvement in NPS and geriatric syndromes (e.g., functional disability and frailty), as well as with all-cause mortality rates among older adults with ADRD in nursing home settings are largely unexplored. The proposed nationwide cohort study explicitly addresses these knowledge gaps. Using the Centers for Medicare and Medicaid Services’ 2018-2020 Medicare claims data (Parts A, B, and D) linked to multiple data sources (e.g., Minimum Data Set [MDS] and National Death Index [NDI]), 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 all-cause mortality rates by ECT use among older adults with ADRD in nursing home settings. 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 cohort study investigating the long-term effectiveness and safety of ECT among older adults with ADRD in nursing home settings. The proposed study is innovative since it will provide a better understanding of ECT use and its association with NPS, geriatric syndromes, and other related health outcomes. Findings from this study will inform clinical guidance on ECT use in older adults with ADRD in nursing home settings.