High Prevalence of Early-Onset Dementia in Schizophrenia Patients

Prevalence of dementia by the point of Medicare eligibility was considerably elevated amongst people with schizophrenia, a retrospective cohort examine discovered.

Utilizing knowledge from a nationwide pattern of Medicare recipients, the prevalence of identified dementia by age 66 was 25 occasions larger for sufferers with schizophrenia, at 27.9% versus 1.3% in people with out a historical past of significant psychological sickness (SMI), reported T. Scott Stroup, MD, MPH, of Columbia College in New York Metropolis, and colleagues.

By age 80, prevalence in these teams elevated to 70.2% and 11.3%, respectively, in response to the findings in JAMA Psychiatry.

In these with out a prior historical past of dementia, the annual incidence of dementia diagnoses at age 66 was 52.5 per 1,000 person-years (95% CI 50.1-54.9) among the many schizophrenia group, however solely 4.5 per 1,000 person-years (95% CI 4.4-4.6) amongst these with out a previous SMI. By 80, incidence of dementia analysis elevated to 216.2 per 1,000 person-years (95% CI 179.9-252.6) for these with schizophrenia and to 32.3 per 1,000 person-years (95% CI 32.0-32.6) for the comparator group.

“When getting older and different threat components for dementia begin accumulating, [individuals with schizophrenia] may cross a threshold for dementia analysis a lot sooner,” Stroup advised MedPage Right this moment.

Stroup’s group acknowledged that the examine’s most vital limitation was that medical diagnoses couldn’t be individually confirmed or validated.

That concern was shared by each Jean-Pierre Lindenmayer, MD, of NYU Langone Well being in New York Metropolis, and Dilip Jeste, MD, of the College of California San Diego, who weren’t concerned within the analysis.

“You by no means fairly know the way psychiatrists and medical practitioners diagnose these individuals and the way correct that’s,” Lindenmayer advised MedPage Right this moment. He added that findings from a lot smaller research, although, have demonstrated that older sufferers with schizophrenia have certainly fashioned early types of dementia.

“I’d even counsel that they might be underestimating the prevalence of the 2 diagnoses mixed,” Lindenmayer mentioned. “Psychiatrists are inclined to underdiagnose dementia as a result of they’re simply not that accustomed to it.”

“We do not know what standards [clinicians] used for diagnosing dementia,” added Jeste, an knowledgeable on learning accelerated organic getting older in sufferers with schizophrenia, including that it is tough to attract conclusions with out detailed examinations.

However Jeste mentioned he was not stunned by the examine’s findings, noting that people with schizophrenia sometimes develop numerous illnesses at youthful ages than the overall inhabitants, together with cognitive illnesses.

“This analysis is an actual place to begin for us to grasp that rather more,” mentioned Stroup. “The following steps will probably be to attempt to determine if we will provide you with particular preventive efforts, after which, as soon as they’ve schizophrenia and dementia collectively, easy methods to greatest assist them deal with these issues.”

The examine used medical knowledge from January 2007 to December 2017 on over 8 million individuals in fee-for-service Medicare and Half D, together with 74,170 people identified with schizophrenia and seven,937,603 people with out a analysis of an SMI.

Vascular dementia accounted for five% of diagnoses within the schizophrenia group by age 66 and 15.6% by age 80. Within the comparator group, vascular dementia accounted for 0.2% of diagnoses by age 66 and for 1.5% by age 80.

Prevalence of Alzheimer’s illness was 8.2% by age 66 within the schizophrenia group and 37.2% by age 80. Within the non-SMI group, prevalence was 0.4% and 5.1% at ages 66 and 80, respectively.

The schizophrenia cohort included the next proportion of males than the comparator group (43.4% vs 36.5%), Black people (20.5% vs 7.8%), and a decrease proportion of girls (56.6% vs 63.5%) and non-Hispanic whites (68.6% vs 81.4%).

With a view to be eligible, schizophrenic adults needed to have at the least two stays in an outpatient facility or one keep in an inpatient facility through the qualifying yr. These from the management group couldn’t have had a analysis of schizophrenia, bipolar dysfunction, or recurrent main depressive dysfunction through the qualifying yr.