Alzheimer's Disease and Co-Morbidity: Increased Prevalence and Possible Risk Factors of Excess Mortality in a Naturalistic 7-Year Follow-Up

Heun, Reinhard; Schoepf, Dieter; Potluri, Rahul; Natalwala, Ammar

doi:10.1016/j.eurpsy.2011.06.001

Cited by 62 publications

(88 citation statements)

References 56 publications

(63 reference statements)

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“…Ten studies 2,12,14,91,118,119,121,127,142,143 reported the prevalence of stroke in people with dementia and two studies 101,134 reported the prevalence of stroke in people with cognitive impairment. Prevalence rates varied from 3% in hospitalised older people in the UK 12 to 34% in a sample of urban and rural community-dwelling people with cognitive impairment in the USA (Figure 4).…”

Section: Strokementioning

confidence: 99%

“…Thirteen studies reported the prevalence of diabetes in populations of people with dementia 2,12,14,91,118,119,121,127,128,142,143 or MCI. 101,134 Prevalence rates varied from 6% to 39%.…”

Section: Diabetesmentioning

confidence: 99%

“…4 In addition, delirium, infections, falls, urinary and faecal incontinence and constipation occur more frequently in PLWD. 1,12 Common health conditions in PLWD include diabetes, vascular or heart disease, hypertension, chronic obstructive pulmonary disease, musculoskeletal disorders and chronic cardiac failure. 1,13,14 There is increasing evidence to support an association between Alzheimer's disease and cardiovascular risk factors such as hypertension and hypercholesterolaemia.…”

Section: Dementia and Comorbiditymentioning

confidence: 99%

“…We included 86 papers, 76 of which were classified as primary references 1,2,12,14,20,21,69,72, and 10 of which were classified as associated papers. 4,73,74,[156][157][158][159][160][161][162] An overview of the selection process can be seen in Figure 2.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Table 13). Data were collected from medical records in seven studies, 12,14,91,127,137,142,144 from clinical examination or interviews in six studies 1,101,118,119,128,134 and from a mixture of medical records and clinical examination in three studies. 2,121,143 The presence of dementia and comorbid medical conditions was assessed using a variety of measures (see Appendix 4, Table 14).…”

Section: Description Of Studiesmentioning

confidence: 99%

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Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Strokementioning

confidence: 99%

“…Thirteen studies reported the prevalence of diabetes in populations of people with dementia 2,12,14,91,118,119,121,127,128,142,143 or MCI. 101,134 Prevalence rates varied from 6% to 39%.…”

Section: Diabetesmentioning

confidence: 99%

Section: Dementia and Comorbiditymentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

Section: Description Of Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

116

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Health Conditions Associated with Alzheimer's Disease and Vascular Dementia

Beason‐Held

Kerley

Chaganti

et al. 2023

Annals of Neurology

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Objective: We examined medical records to determine health conditions associated with dementia at varied intervals prior to dementia diagnosis in participants from the Baltimore Longitudinal Study of Aging (BLSA). Methods: Data were available for 347 Alzheimer's disease (AD), 76 vascular dementia (VaD), and 811 control participants without dementia. Logistic regressions were performed associating International Classification of Diseases, 9th Revision (ICD-9) health codes with dementia status across all time points, at 5 and 1 year(s) prior to dementia diagnosis, and at the year of diagnosis, controlling for age, sex, and follow-up length of the medical record. Results: In AD, the earliest and most consistent associations across all time points included depression, erectile dysfunction, gait abnormalities, hearing loss, and nervous and musculoskeletal symptoms. Cardiomegaly, urinary incontinence, non-epithelial skin cancer, and pneumonia were not significant until 1 year before dementia diagnosis. In VaD, the earliest and most consistent associations across all time points included abnormal electrocardiogram (EKG), cardiac dysrhythmias, cerebrovascular disease, non-epithelial skin cancer, depression, and hearing loss. Atrial fibrillation, occlusion of cerebral arteries, essential tremor, and abnormal reflexes were not significant until 1 year before dementia diagnosis. Interpretation: These findings suggest that some health conditions are associated with future dementia beginning at least 5 years before dementia diagnosis and are consistently seen over time, while others only reach significance closer to the date of diagnosis. These results also show that there are both shared and distinctive health conditions associated with AD and VaD. These results reinforce the need for medical intervention and treatment to lessen the impact of health comorbidities in the aging population.

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Differences in survival and mortality in minority ethnic groups with dementia: A systematic review and meta‐analysis

Couch

Gao

et al. 2021

Int J Geriat Psychiatry

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Objectives Although there are disparities in both risk of developing dementia and accessibility of dementia services for certain minority ethnic groups in the United States and United Kingdom, disparities in survival after a dementia diagnosis are less well‐studied. Our objective was to systematically review the literature to investigate racial/ethnic differences in survival and mortality in dementia. Methods We searched Embase, Ovid MEDLINE, Global Health and PsycINFO from inception to November 2018 for studies comparing survival or mortality over time in at least two race/ethnicity groups. Studies from any country were included but analysed separately. We used narrative synthesis and random‐effects meta‐analysis to synthesise findings. The Newcastle–Ottawa Scale was used to assess quality and risk of bias in individual studies. Results We identified 22 articles, most from the United States (n = 17), as well as the United Kingdom (n = 3) and the Netherlands (n = 1). In a meta‐analysis of US studies, hazard of mortality was lower in Black/African American groups (Pooled Hazard Ratio = 0.86, 95% CI = 0.82–0.91, I2 = 17%, from four studies) and Hispanic/Latino groups (Pooled HR = 0.65, 95% CI = 0.50–0.84, I2 = 86%, from four studies) versus comparison groups. However, study quality was mixed, and in particular, quality of reporting of race/ethnicity was inconsistent. Conclusion Literature indicates that Black/African American and Hispanic/Latino groups may experience lower mortality in dementia versus comparison groups in the United States, but further research, using clearer and more and consistent reporting of race/ethnicity, is necessary to understand what drives these patterns and their implications for policy and practice.

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Alzheimer's Disease and Co-Morbidity: Increased Prevalence and Possible Risk Factors of Excess Mortality in a Naturalistic 7-Year Follow-Up

Cited by 62 publications

References 56 publications

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Health Conditions Associated with Alzheimer's Disease and Vascular Dementia

Differences in survival and mortality in minority ethnic groups with dementia: A systematic review and meta‐analysis

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