Identifying Risk Factors and Treatment Strategies for Dementia in People with Schizophrenia

精神分裂症患者患痴呆症的风险高得不成比例

Individuals with schizophrenia are at disproportionally high risk of developing dementia with published estimates ranging from 2.1-fold to 5.8-fold increased risk across the lifespan. Yet despite this remarkably elevated risk, little is known about the factors that contribute to the co-occurrence of schizophrenia and dementia and the clinical consequences of this comorbidity. To ameliorate the increased risk of dementia among adults with schizophrenia, there is a great need to identify risk factors, especially potentially modifiable risk factors, for dementia in this population. In addition, there are no practice guidelines or even generally accepted standards of care to inform clinical assessment and treatment of patients with co-occurring schizophrenia and dementia. This proposed project addresses critical unanswered questions for people with schizophrenia at risk for dementia and for those with co-occurring dementia and schizophrenia. We will use national longitudinal claims records from Medicaid (2007-2022) and Medicare (2007-2022) representing >75% of people with schizophrenia in the US. Applying rigorous epidemiological and pharmacoepidemiological methods to national Medicare and Medicaid claims records will offer the opportunity to parse dementia risk factors within middle aged and older adults with schizophrenia. The analyses will include a specific focus on understanding risk factors for dementia among Black, Indiginous and People of Color (BIPOC) individuals with schizophrenia. We will also provide important new information on the safety of antipsychotic medications in people with co-occurring dementia and schizophrenia. Based on these results and using expert input and consensus methods, we will adapt and evaluate a Cognitive Health Toolkit to aid in the clinical assessment and treatment of cognitive impairments in middle aged and older adults with schizophrenia. This study will increase our understanding of dementia in schizophrenia by addressing pressing questions regarding risk factors, especially modifiable risk factors, and providing an urgently needed evaluation of the effects of alternative antipsychotic medications on the course of patients with schizophrenia and dementia. The project will also yield a clinical toolkit to aid in the evaluation and management of cognition health in this vulnerable population.