The importance of detecting and managing comorbidities in people with dementia?

Abstract

CommentaryDementia is a debilitating condition characterised by global loss of cognitive and intellectual functioning, which gradually interferes with social and occupational performance. It is a common worldwide condition with a significant impact on society. There are currently 36 million people worldwide with Alzheimer's disease (AD) and other dementias [1]. This is expected to more than double by 2030 (65 million) and reach 115 million in 2050, unless a major breakthrough is made. The worldwide societal costs were estimated at USD 604 billion in 2010 and rising [2].To date research on the specific physical healthcare needs of people with dementia has been neglected. Yet, physical comorbidities are reported as common in people with dementia [3] and have been shown to lead to increased disability and reduced quality of life for the affected person and their carer [4].Dementia is most frequently associated with older people who often present with other medical conditions, known as co-morbidities. Such co-morbidities include diabetes, chronic obstructive pulmonary disorder, musculoskeletal disorders and chronic cardiac failure and are common, 61% of people with dementia are estimated to have three or more comorbid diagnoses [5]. Musculoskeletal, genitourinary, and ear, nose and throat disorders have been reported as highly prevalent, affecting nearly half of people with dementia [6]. Physical comorbidities are often treatable and some may be reversible. Epilepsy, delirium, falls, oral disease, malnutrition, frailty, incontinence, sleep disorders and visual dysfunction are found to occur more frequently in dementia sufferers and untreated can lead to more severe health problems, pain and distress as well as worsening the symptoms of dementia itself [6]. As the severity of the dementia increases, so does the rate of comorbid conditions such as genitourinary disorders [6]. Pneumonia, urinary tract infection and congestive cardiac failure accounted for two-thirds of preventable admissions in dementia with dehydration and duodenal ulcer the next most important [7]. Healthcare costs for treating these problems are high, estimated at being 34% more costly than in age-matched, non-dementia cases [8]. The annual admission rate is double that of patients without dementia [7].In the UK, NICE guidelines for the treatment of dementia assert that the promotion and maintenance of independence and everyday functioning is a key treatment for those diagnosed with dementia [9]. At the core of this should be a comprehensive assessment of needs, difficulties and possible co-morbid symptoms. Timely identification of physical symptoms in those with dementia has been linked to decreased risk of hospitalisation [10], reduced healthcare costs [11] and the maintenance of physical comfort and quality of life [12,13].In addition the diagnosis and management of co-morbid conditions is recognised as being poor, as dementia dominates clinical encounters and shifts attention away from the co-morbidity [14] which can lead to increased morbidity ...

Screening Younger Individuals in a Primary Care Setting Flags Putative Dementia Cases and Correlates Gastrointestinal Diseases with Poor Cognitive Performance

“…Comorbid conditions have been associated with dementia [48]; for instance, diabetes is associated with an increased rate of cognitive decline [49]. As discussed in the Results section, in the pcb-Cohort correlations with comorbidities were likewise evident, and there was a significant correlation with GID.…”

Multimorbidity and healthcare utilization among home care clients with dementia in Ontario, Canada: A retrospective analysis of a population-based cohort

“…They highlight the need to develop effective interventions targeted to the particular needs of this population. Unique challenges exist in detecting and managing comorbidities for dementia patients [40], including difficulties in communicating medical complaints because of memory and language deficits. Clinical encounters may also be dominated by dealing with dementia and its manifestations, to the exclusion of other conditions.…”

Reach the Person behind the Dementia - Physical Therapists' Reflections and Strategies when Composing Physical Training

“…For example, one study showed that almost all (94%) nursing-home residents with dementia over a period of six weeks had changes to their health condition status, and many of the symptoms were considered treatable or reversible [25]. Early recognition and treatment of new conditions and exacerbations of ongoing conditions is thus of great importance [26]. It has been emphasized by assistant nurses that teamwork is a key component to engage people with dementia in activities, partly because of the opportunities to report and discuss their changing status [10].…”