Dementia and Schizophrenia Study Guide

Dementia

A progressive neurodegenerative disorder that impacts memory, thinking, and behavior.

Alzheimer's prevalence in the US

~7 million Americans 65+ (2024), 1 in 9 age 65+, 73% are 75+; ~13 million projected by 2050.

Global dementia prevalence

~55 million (2024); 139 million by 2050; 60% in middle-/low-income countries; 71% by 2050.

Undiagnosed dementia

75% undiagnosed worldwide; 35% of caregivers globally have hidden diagnosis.

Sex and race/ethnicity disparities in Alzheimer's

2/3 of US Alzheimer's patients are women; higher prevalence in Black (~2x) and Hispanic (~1.5x) adults.

Burden of Alzheimer's

5th leading cause of death (65+); $360B in care; 11M unpaid caregivers in US.

Neurobiological causes of dementia

Beta-amyloid plaques, tau tangles, brain atrophy.

Signs vs. normal aging

Dementia = memory, judgment, communication issues vs. slower thinking in aging.

Risk Factors for dementia

Nonmodifiable: age, family history, APOE, sex, race; Modifiable: education, head trauma, CV health, mental activity, sleep, pollution.

Management of dementia

7 drugs (1 disease-modifying); goals: quality of life, functioning, safety, engagement.

Unique Aspects of dementia

Financial, stigma, abuse risk, caregiver burden.

Public Health's Role in dementia

Surveillance: BRFSS modules; Risk Reduction: brain/heart health; Early Detection: only 35% know diagnosis; Safety/Quality: caregiver resources, workforce training.

AAPI Community and dementia

Cultural stigma, filial piety, SEM context.

Dementia Villages

Netherlands; dignity, autonomy; costly, limited; SEM relevance.

Schizophrenia

Mental illness affecting thoughts, perceptions, behaviors.

Symptoms of schizophrenia

Positive: hallucinations, delusions; Negative: avolition, alogia; Cognitive: attention, memory, abstract thinking.

Misconceptions about schizophrenia

Not multiple personality disorder; not inherently violent.

Dopamine Hypothesis

Excess dopamine causes symptoms; drugs target dopamine.

Brain changes in schizophrenia

Enlarged ventricles, reduced frontal blood flow, structural abnormalities.

Risk Factors for schizophrenia

Biological: genetics, birth complications; Environmental: SES, urban living, cannabis use.

Diathesis-Stress Model

Genetic predisposition + environmental trigger.

Comorbidities in schizophrenia

50% have another mental/behavioral disorder.

Onset & Course of schizophrenia

Teens-20s onset; often chronic; 1/3 institutionalized.

Prevalence of schizophrenia

24 million globally; ~0.32%; 0.25-0.64% in US.

Sex Differences in schizophrenia

More common in males; males = negative symptoms; females = positive.

Race/Ethnicity and schizophrenia

Higher rates in Black & Hispanic Americans; bias and risk factors?

Burden of schizophrenia

Disability, suicide, heart/liver disease, $343B costs, 28.5 YPLL.

Prevention of schizophrenia

Primary = prevent onset; Secondary = early detect; Tertiary = manage symptoms; Universal = all; Selective = at risk; Indicated = early symptoms.

Clinical High Risk

Subtle symptoms; goal = delay/prevent psychosis.

Early Intervention & CSC

Focus on DUP & 2-5 year window; components: meds, CBT, family, job support.

Effectiveness of CSC

Improves remission, lowers relapse, boosts social/work function.

CSC Barriers

Stigma, culture, disengagement, rural access, funding.

NPR Clip

Insurance access to CSC.

RAISE Study

NIMH study; 'Navigate' program; better outcomes than standard care.

CSC Expansion

340+ programs; federal funding increased.

EPINET

National network of CSCs; standardized metrics and national tracking.