ECT does not worsen functional outcomes in those with depression, dementia

For older adults with dementia and comorbid depression, receiving electroconvulsive therapy does not worsen the trajectory of functional outcomes, according to a study from the Journal of Clinical Psychiatry.

“Electroconvulsive therapy is an effective and safe treatment for a range of psychiatric disorders, including treatment-resistant depression,” Samuel T. Wilkinson, MD, of the Yale Depression Research Program in the department of psychiatry at Yale School of Medicine, and colleagues wrote. “ECT has been shown to be associated with lower risks of all-cause mortality and a short-lived but significant reduction in suicide risk in older adults.”

Wilkinson and colleagues wrote that they wanted to enrich the “growing literature” surrounding effective treatments for behavioral and psychological symptoms of dementia by examining the potential of ECT within a large sample of individuals diagnosed with comorbid depression and dementia.

The researchers drew data from a nationally representative sample of Medicare claims data between 2014 and 2015 and found 147 participants aged 65 years and older with continuous coverage in the study interval, a diagnosis of major depressive disorder along with Alzheimer’s disease or related dementias and who were hospitalized between January 2014 and September 2015. A separate cohort of 415 controls were not given ECT. Cognitive functioning was rated zero to four, with four rating as totally dependent due to disorientation, coma or delirium. Functional outcomes for the study population were compared before and after hospitalization (when ECT was initiated for the ECT cohort). Bivariate analyses were utilized to measure functional changes around hospitalization, with linear mixed models used to assess cognitive function, ability to walk and disruptive behaviors.

Results showed that 103 of 147 (70.1%) of participants in the ECT group and 299 of 415 (72%) in the control group recorded pre- and post-hospitalization scores for functional changes.

Researchers found a general decline across all functional outcomes over the entire study interval, with those in the ECT group posting a slower rate of functional decline in bathing (Cohen d=–0.05 vs 0.38) and transferring (d=0.18 vs 0.45; P=.031) compared with matched controls. Multivariate analysis further revealed that those selected to receive ECT fared better in the overall activities of daily living summary score at 180 days (coefficient=0.1; 95% CI, 0.19 to 0.01), although improvement was not statistically significant. No difference was seen in cognition or ambulation between either group.

“The data from this report suggest that ECT may improve the trajectory of functional outcomes among older adults with dementia, although the effect may be small,” Wilkinson and colleagues wrote.