Association of electroconvulsive therapy with health outcomes in older adults with co-occurring depression and dementia

摘要 躁动和攻击在老年痴呆症患者中很常见。到目前为止，还没有FDA批准的 可用于管理这些症状的治疗策略。此外，标签外使用的治疗 (i.e.,抗精神病药物）在这种临床背景下具有与它们相关的显著风险。初步报告 表明电休克治疗（ECT）可能是有效的治疗在这种情况下。一些 小型的组内比较研究报告称， 痴呆患者ECT治疗后的功能水平。然而，一些限制限制了 这些结论，包括小样本量和研究中缺乏对照组。此外，委员会认为， 这些报告没有超过ECT初始索引系列（仅3-5周）的长期随访。 拟议的补充研究将通过进行倾向评分来填补这些知识空白 匹配的观察性队列，样本量相当（每组N~1000），持续时间（1-2年），使用 全国医疗保险索赔数据。本申请是对NOT-AG-20-008的响应，该申请要求 补充项目，以“扩大现有的奖项，目前不集中在阿尔茨海默病及其 相关痴呆症（AD/ADRD）”，这将导致随后的独立研究项目。 本研究的目的是：1）研究ECT使用与长期破坏性行为的关系 症状（例如，攻击和激动）;和2）评估ECT使用与长期认知功能的关系。 和身体功能的结果在老年人共病抑郁症和痴呆症。我们将 比较接受ECT治疗和不接受ECT治疗的患者（非ECT组）随时间推移的结果。 感兴趣的结果来自OASIS调查，这是一项全面的季度评估， 老年痴呆症患者在养老院。该调查包含行为、认知和功能方面的详细数据 结果。数据将来自65万名65岁或以上受益人的医疗保险数据，这些数据已经在- 房子的父母补助金。鉴于现有的数据库，我们的初步数据查询表明，我们将有 有足够的数据对2,000名患者进行纵向研究。我们将使用倾向评分匹配队列， 确定一组没有接受ECT治疗的患者，这些患者在其他方面与接受ECT治疗的患者相当。一个混合的- 将利用模型分析来审查一段时间内的成果。 我们的假设是，与非ECT组相比，ECT组的结局更好。我们 考虑到内部存在的数据集和 补充通知的限制，工作必须在一年内完成。从这个有希望的发现 这项研究将提供初步数据，以进行更大规模的独立研究， 没有抑郁症的痴呆症患者的代表性样本，使预期的发现更多 可概括的，与实践相关的。

ABSTRACT Agitation and aggression are common in older adults with dementia. To date, there is no FDA-approved treatment strategy available for managing these symptoms. Furthermore, treatments that are used off-label (i.e., antipsychotics) in this clinical context have significant risks associated with them. Preliminary reports suggest that electroconvulsive therapy (ECT) may be efficacious as a treatment in this context. A number of small, within-group comparison studies have reported a general improvement in agitation, aggression, and level of functioning following ECT in patients with dementia. However, several limitations limit the certainty of these conclusions, including the small sample size and lack of a control group in the studies. Furthermore, these reports do not have long-term follow-up beyond the initial index series of ECT (only 3-5 weeks). The proposed supplement study will fill these gaps in knowledge by conducting a propensity-score matched observational cohort of respectable sample size (N~1000 per group) and duration (1-2 years) using nationally representative Medicare claims data. This application is in response to NOT-AG-20-008, which calls for supplemental projects to “expand existing awards not currently focused on Alzheimer’s disease and its related dementias (AD/ADRD)” which will lead to subsequent independent research projects. This project will aim to 1) examine the association of ECT use with long-term disruptive behavioral symptoms (e.g., aggression and agitation); and 2) evaluate the association of ECT use with long-term cognitive and physical functional outcomes among older adults with co-morbid depression and dementia. We will compare outcomes over time across those who receive ECT and those who do not (non-ECT group). The outcomes of interest come from the OASIS survey, a comprehensive quarterly assessment of dementia patients in nursing homes. This survey contains detailed data on behavioral, cognitive, and functional outcomes. Data will be drawn from Medicare data of 650,000 beneficiaries aged 65 or older that is already in- house for the parent grant. Given this existing database, our preliminary data queries suggest we will have sufficient data for a longitudinal study of 2,000 patients. We will use a propensity-score matched cohort to identify a group of patients who do not receive ECT who are otherwise comparable to those who do. A mixed- model analysis will be utilized to examine outcomes over time. Our hypothesis is that ECT is associated with better outcomes compared to the non-ECT group. Our focus on comorbid depression/dementia is out of convenience given the dataset that exists in-house and the limitations of the supplement notice that the work must be completed in one year. Promising findings from this study would provide preliminary data to undertake a larger, independent study of this association in a more representative sample of individuals with dementia without depression, making anticipated findings more generalizable and relevant to practice.