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）是最普遍的，令人衰弱的神经变性。 衰老疾病和神经精神症状（NP）的当前治疗方法（例如，躁动，侵略， ADRD的抑郁症是混合的。建议采用非药理行为干预措施 作为对ADRD的NP的一线治疗，它们需要大量的时间和资源，并且可能更少 对严重搅动，侵略性或抑郁的ADRD患者有效。 电击疗法（ECT）是针对一系列精神疾病的有效且安全的治疗， 包括耐药性抑郁症，精神分裂症和躁郁症。案例系列和 自然研究支持ECT治疗严重搅动，侵略性， 抑郁症或ADRD中的其他NP。迄今为止，ECT与NP的长期改善和 老年综合症（例如功能下降和脆弱），以及医院和护士的入学 率和全因死亡率在很大程度上是出乎意料的。拟议的全国队列研究明确 解决这些知识差距。 使用Medicare和Medicaid Services中心的2016-2019 Medicare索赔数据（A，B部分和 d）与多个数据源相关（例如，家庭健康结果和评估信息集，Medicare 当前的受益人调查和国家死亡指数），该拟议的研究具有以下特定 目的：1）检查ECT使用以及社会人口统计学和临床​​因素的发病率和患病率 与ECT使用相关； 2）研究ECT与NP和老年综合征的纵向关联； 3）检查医院或护士家庭入院率和全因死亡率的差异风险 ECT在ADRD的老年人中使用。纵向数据分析，例如广义线性混合建模 竞争风险回归方法将用于目标2和3。在这项全国人群研究中，我们将 员工倾向得分匹配和仪器可变技术，以调整观察到的 未观察到的混杂因素。还将进行意图对处理和经过处理的分析。较早的研究支持 该ECT与ADRD NP的改善有关，我们的分析表明，ECT在存在下使用 抑郁症和ADRD都与全因死亡率的可能性较低有关；我们这样 假设ECT也可以保护老年综合症。 这是全国第一项纵向队列研究，研究了长期有效性和安全性 ADRD成年人的ECT。拟议的研究具有创新性，因为它将更好地理解ECT 使用及其与NP，老年综合征和其他健康结果的关联。这项研究的发现将 为ADRD的老年人提供有关ECT使用的临床指南。