Comorbidity of dementia: a cross-sectional study of primary care older patients

Abstract

BackgroundThe epidemiologic study of comorbidities of an index health problem represents a methodological challenge. This study cross-sectionally describes and analyzes the comorbidities associated with dementia in older patients and reviews the existing similarities and differences between identified comorbid diseases using the statistical methods most frequently applied in current research.MethodsCross-sectional study of 72,815 patients over 64 seen in 19 Spanish primary care centers during 2008. Chronic diseases were extracted from electronic health records and grouped into Expanded Diagnostic Clusters®. Three different statistical methods were applied (i.e., analysis of prevalence data, multiple regression and factor analysis), stratifying by sex.ResultsThe two most frequent comorbidities both for men and women with dementia were hypertension and diabetes. Yet, logistic regression and factor analysis demonstrated that the comorbidities significantly associated with dementia were Parkinson’s disease, congestive heart failure, cerebrovascular disease, anemia, cardiac arrhythmia, chronic skin ulcers, osteoporosis, thyroid disease, retinal disorders, prostatic hypertrophy, insomnia and anxiety and neurosis.ConclusionsThe analysis of the comorbidities associated with an index disease (e.g., dementia) must not be exclusively based on prevalence rates, but rather on methodologies that allow the discovery of non-random associations between diseases. A deep and reliable knowledge about how different diseases are grouped and associated around an index disease such as dementia may orient future longitudinal studies aimed at unraveling causal associations.

Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data

“…The same authors note that even when illness burden is controlled for, the care costs of patients with dementia may be up to 34% higher than those of aged matched controls, with outpatient pharmaceuticals being the key driver of cost difference [20]. A recent Spanish primary care based study found increased rates of Parkinson's disease and cerebrovascular disease, consistent with this dataset, [21] but additionally reported higher rates of thyroid conditions, heart disease, retinal disorder and prostatic hypertrophy. This sample of 3,971 people with dementia was however, considerably smaller than the population reported here.…”

Thalassemia and risk of dementia: A nationwide population-based retrospective cohort study

“…These included hypertension, diabetes, and other comorbidities such as congestive heart failure, cerebrovascular disease, and cardiac arrhythmia that have been significantly associated with dementia [15]. Anemia is a recognized risk factor as well as above risk factors to develop dementia.…”

The economic burden of dementia in China, 1990–2030: implications for health policy

“…Given the increasing awareness and use of health services for dementia, it also seems likely that the costs of medical services will increase more rapidly in the coming decades than by 5% annually, that is, by the rate we used in our sensitivity analysis. Third, as people with dementia often suffer from other chronic health conditions, 50 , 51 comorbidities might reduce the accuracy of our estimates of dementia costs. Fourth, data on the proportion of patients with dementia seeking professional care were very limited.…”