Table_2_Electroconvulsive Therapy and Risk of Dementia—A Nationwide Cohort Study in Taiwan.DOC

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.

背景：电抽搐治疗（Electroconvulsive therapy, ECT）是精神分裂症、双相情感障碍及重度抑郁症的有效治疗手段，但治疗后可能出现暂时性记忆缺损。然而，精神分裂症、双相情感障碍与重度抑郁症患者接受ECT后与痴呆风险的关联仍有待探明。
目的：本研究旨在借助中国台湾地区全民健康保险研究数据库（National Health Insurance Research Database, NHIRD），明确上述三类精神疾病患者接受ECT后是否会增加痴呆发病风险。
方法：研究从NHIRD中筛选2000年1月1日至2000年12月31日期间的3796名入组受试者，其中精神分裂症患者占46.68%、双相情感障碍患者占11.77%、重度抑郁症患者占41.55%；包含994名接受ECT的患者，以及2982名按性别与年龄匹配的对照个体。在校正混杂因素后，本研究采用Fine与Gray生存分析法，比较两组受试者10年随访期间的痴呆发病风险。
结果：本研究队列中有45名（4.53%）患者罹患痴呆，对照组则有149名（5.0%）。Fine与Gray生存分析结果显示，研究队列并未出现痴呆发病风险升高的情况[风险比（hazard ratio, HR）=0.612，95%置信区间（confidence interval, CI）=0.438–1.854，P=0.325]。在校正性别、年龄、月收入、城市化水平、地理区域及合并症后，校正后HR为0.633（95% CI=0.448–1.895，P=0.304）。
结论：基于NHIRD数据的本研究证实，精神分裂症、双相情感障碍与重度抑郁症患者接受ECT后，并未显著增加痴呆发病风险。