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

> **NIH NIH R21** · YALE UNIVERSITY · 2020 · $221,529

## Abstract

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 ...

## Key facts

- **NIH application ID:** 10119074
- **Project number:** 3R21MH117438-02S1
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** SAMUEL WILKINSON
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $221,529
- **Award type:** 3
- **Project period:** 2019-03-05 → 2021-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10119074

## Citation

> US National Institutes of Health, RePORTER application 10119074, Association of electroconvulsive therapy with health outcomes in older adults with co-occurring depression and dementia (3R21MH117438-02S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10119074. Licensed CC0.

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