Electroconvulsive Therapy and Risk of Dementia—A Nationwide Cohort Study in Taiwan

Abstract

Background: Electroconvulsive therapy (ECT) is an effective treatment for schizophrenia, bipolar disorder, and major depressive disorder, and a temporary memory loss may occur after ECT. However, the association between ECT in patients with schizophrenia, bipolar disorder, and major depressive disorder, and the risk of dementia is yet to be examined.Objective: This study aimed to clarify as to whether ECT is associated with the risk of dementia after ECT in patients with schizophrenia, bipolar disorder, and major depressive disorder, using Taiwan's National Health Insurance Research Database (NHIRD).Methods: A total of 3,796 enrolled participants (schizophrenia, 46.68%; bipolar disorder, 11.77%; and major depressive disorder, 41.55%) with 994 patients who had received ECT and 2,982 controls matched for sex and age, between January 1, and December 31, 2000, were selected from the NHIRD. After adjusting for confounding factors, Fine and Gray's survival analysis was used to compare the risk of developing dementia during the 10 years of follow-up.Results: Of the study patients, 45 (4.53%) of them developed dementia when compared to 149 (5.0%) in the control group. Fine and Gray's survival analysis revealed that the study patients were not associated with an increased risk of dementia [hazard ratio (HR) = 0.612, 95% confidence interval (CI) = 0.438–1.854, P = 0.325]. After adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities, the adjusted HR was 0.633 (95% CI = 0.448 – 1.895, P = 0.304).Conclusion: This study supports that ECT was not associated with the increased risk of dementia in patients with schizophrenia, bipolar disorder, and major depressive disorder, using the NHIRD.

Depressive Symptoms in the Elderly—An Early Symptom of Dementia? A Systematic Review

“…One strong argument for the true risk hypothesis would be clinical trials indicating that successful treatment of major depressive episodes lowers the incidence of (solidly diagnosed) degenerative dementia. This is a controversial question, with multiple studies of different (mainly pharmacological) treatments providing conflicting results (Lee et al, 2016;Jacob et al, 2017;Almeida et al, 2017;Chu et al, 2018;Brauer et al, 2019). We further note that the successful treatment of clinical depression is a challenge in itself, as only one in three patients respond to first-line treatments and as many remain treatment resistant after multiple treatments, a situation that may be even more frequent in the elderly (Rush et al, 2006).…”

Are Anticholinergic Medications Associated With Increased Risk of Dementia and Behavioral and Psychological Symptoms of Dementia? A Nationwide 15-Year Follow-Up Cohort Study in Taiwan

“…The enrolled participants exceeded 99% of the population and were contracted with 97% of the medical providers (Ho Chan, 2010). The details of this program have been documented in previous studies (Huang et al, 2014;Tang et al, 2015;Yang et al, 2015a;Tzeng et al, 2016;Tzeng et al, 2017a;Tzeng et al, 2017c;Chao et al, 2018;Chu et al, 2018;Tzeng et al, 2018;Tzeng et al, 2019b). The data sources of the present study were two million randomly sampled patients from the Longitudinal Health Insurance Database (LHID), a subset of the NHIRD, over a 15-year period (2000NHIRD, over a 15-year period ( -2015.…”

<p>Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives</p>

“…145 While few systematic studies of longterm cognitive outcomes have been reported, two large cohort studies found ECT was not associated with incident dementia in those who received ECT. 146,147 Common side effects are headache, myalgias, and memory deficits. Memory impairments, when present, typically return to normal within weeks after an ECT course, and objectively resolve by six months posttreatment.…”