OPAL 1 ADRD Supplement Project

Understanding the Co-occurrence of Schizophrenia and Alzheimer’s Disease and Related Dementias

The NIMH OPAL Center (P50 MH115843) is dedicated to conducting research that addresses important issues in the treatment and delivery of services for schizophrenia across the lifespan.  Alzheimer's Disease and its related Dementias (ADRD) are common among people diagnosed with schizophrenia and the combination is thought to be associated with worse outcomes than either condition alone.  This investigation will characterize important aspects of the co-occurrence of these conditions and will generate hypotheses and preliminary data for future research on the vulnerable and understudied population of patients with both schizophrenia and ADRD.  In addition to characterizing the incidence, service use, and outcomes of this population, we will examine their patterns of medication use.  Medication use in this patient population is particularly important given that first-line treatments for schizophrenia, antipsychotic medications, are associated with increased mortality risk in elderly dementia patients and are labeled with a black box warning for this group.

We propose a 1-year administrative supplement to conduct a set of complementary analyses to characterize important aspects of the co-occurrence of schizophrenia and ADRD in a large cohort of older Americans.  We will use nationally representative longitudinal data on millions of Medicare beneficiaries from 2007-2016 to identify two demographically matched retrospective longitudinal cohorts of patients aged 66 years and older, one with schizophrenia and one without serious mental illness, neither of which have received an ADRD diagnosis or received treatment with an ADRD medication during the year prior to cohort inception.

Investigators:

What we found:

In this cohort study of 8,011,773 individuals in a national Medicare database from 2007 to 2017, at 66 years of age, 27.9% of individuals with schizophrenia also had a dementia diagnosis compared with 1.3% of individuals without a serious mental illness. The prevalence of dementia diagnoses among people with schizophrenia at 66 years of age was similar to the prevalence at 88 years of age for the group without serious mental illness.

The findings suggest that further study is needed about the processes and impairments that lead to dementia diagnoses in patients with schizophrenia as well as prevention and treatment strategies.

Publications:

  1. Stroup TS, Olfson M, Huang C, Wall MM, Goldberg T, Devanand DP, Gerhard T, Age-Specific Prevalence and Incidence of Dementia Diagnoses Among Older US Adults With Schizophrenia, JAMA psychiatry. Published online March 10, 2021. PMCID: PMC7948106 (Link)
  2. Olfson M, Stroup TS, Huang C, Wall MM, Gerhard T. Age and Incidence of Dementia Diagnosis. J Gen Intern Med. 2021 Jul;36(7):2167-2169. doi: 10.1007/s11606-020-05895-y. Epub 2020 Jun 3. PMID: 32495094; PMCID: PMC8298619 (Link)

Presentations:

  1. Gerhard T, Stroup TS, Wall M, Huang C, Olfson M. Co-Occurrence of Schizophrenia and Dementia. Pharmacoepidemiology and Drug Safety, 2020;29(S3):71-2. Presented at the International Conference for Pharmacoepidemiology (Annual Meeting of the International Society for Pharmacoepidemiology. September 2020. Virtual Meeting. 
  2. Scott Stroup, Tobias Gerhard, Melanie Wall, Devangere Devanand, Mark Olfson, Incidence of Dementia Among Older Adults with Schizophrenia in the U.S. Poster presentation at 2nd Columbia Psychiatry Science Celebration/Poster Session on January 29, 2020

Grants:

This work leads to OPAL renewal application Signature project