Comorbidity and clinical features in elderly patients with dementia: Differences according to dementia severity

Formiga, Francesç; Fort, Isabel; Robles, María José; Riu, S. De; Sabartés, Olga; Barranco, E.; Catena, J.

doi:10.1007/s12603-009-0078-x

Cited by 57 publications

(46 citation statements)

References 27 publications

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“…Disease stage and the care setting from which patients are recruited are likely to influence the prevalence of and identification of physical conditions across different study populations [4,[6][7][8]. For co-morbidity these results broadly agree with the findings of the only other large routine heath dataset published to date, which described administrative claims data and recorded higher comorbid conditions among people with dementia than their matched controls [9].…”

Section: Comparison With Related Worksupporting

confidence: 78%

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

et al. 2016

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1Co-morbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data Word count: 2,303 Competing interestsWe declare the following interests: BG and GM report grants from the Chief Scientist Office ARPG 07/01 during the conduct of the study. Authors' ContributionsBG and SWM conceived the idea of the study. GMcL carried out statistical analysis and drafting of the results and methodology with BG. FC drafted literature review and interpretation of findings with BG, ER and SWM. All authors contributed to draft revisions. All authors approved the final version before submission. SWM is the guarantor for this study. AcknowledgementsThis analysis had no external funding. The original study which created the dataset was funded by Scottish Government Chief Scientist Office Applied Research Programme Grant 07/01. The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report, or the decision to submit for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. We would like to thank all the practices which gave permission for the data to be used for research and the Primary Care Clinical Informatics Unit at the University of Aberdeen, which provided the data contained herein. The views in this publication are not necessarily the views of the University of Aberdeen, its agents, or employees. We thank Katie Wilde and Fiona Chaloner of the University of Aberdeen, who did the initial data extraction and management. This paper reports a large cross sectional study of polypharmacy and physical comorbidity among older people with dementia.People with dementia had more physical conditions and were also prescribed more medications than those without dementia.This data highlights the importance of integrating specialist and non-specialist care to support complex symptom management.

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Section: Comparison With Related Worksupporting

confidence: 78%

“…specialist or inpatient cohorts, specific dementia types) and the way in which comorbidity is measured [3][4][5][6][7][8][9]. The extent of multiple medication use (polypharmacy) in dementia has been little studied.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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“…Higher medical comorbidity not only accelerates functional deterioration leading to the under-diagnosis and under-treatment of dementia and comorbid illnesses, but also has significant implications for poorer self-care, immobility, and polypharmacy [22–24]. Our study showed the burden of comorbidities is significantly high in older adults with cognitive impairment.…”

Section: Discussionmentioning

confidence: 79%

Comorbidity and dementia: A nationwide survey in Taiwan

et al. 2017

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BackgroundComorbid medical diseases are highly prevalent in the geriatric population, imposing hardship on healthcare services for demented individuals. Dementia also complicates clinical care for other co-existing medical conditions. This study investigated the comorbidities associated with dementia in the elderly population aged 65 years and over in Taiwan.MethodsWe conducted a nationwide, population-based, cross-sectional survey; participants were selected by computerized random sampling from all 19 Taiwan counties between December 2011 and March 2013. After exclusion of incomplete or erroneous data, 8,456 subjects were enrolled. Of them, 6,183 were cognitively normal (control group), 1,576 had mild cognitive impairment (MCI), and 697 had dementia. We collected information about types of comorbidities (i.e., vascular risk factors, lung diseases, liver diseases, gastrointestinal diseases, and cancers), Charlson comorbidity index score, and demographic variables to compare subjects with normal cognition, MCI, and dementia.ResultsRegardless of the cognitive condition, over 60% of the individuals in each group had at least one comorbid disease. The proportion of subjects possessing at least three comorbidities was higher in those with cognitive impairment (MCI 20.9%, dementia 27.3%) than in control group (15%). Hypertension and diabetes mellitus were the most common comorbidities. The mean number of comorbidities and Charlson comorbidity index score were greater in MCI and dementia groups than in control group. Logistic regression demonstrated that the comorbidities significantly associated with MCI and dementia were cerebrovascular disease (OR 3.35, CI 2.62–4.28), cirrhosis (OR 3.29, CI 1.29–8.41), asthma (OR 1.56, CI 1.07–2.27), and diabetes mellitus (OR 1.24, CI 1.07–1.44).ConclusionMultiple medical comorbid diseases are common in older adults, especially in those with cognitive impairment. Cerebrovascular disease, cirrhosis, asthma, and diabetes mellitus are important contributors to cognitive deterioration in the elderly. Efforts to lower cumulative medical burden in the geriatric population may benefit cognitive function.

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“…Clinical data on this issue are scarce and somehow contradictory. In most studies, cancer seems to be a prevalent comorbidity for patients with AD, and for males in particular (Gambassi et al, 1999;Gasper et al, 2005), although specific proportions vary from 8% (Formiga et al, 2007(Formiga et al, , 2008 to almost 23% in patients with reported exposure to carcinogens (Yamada et al, 1999). Other studies find that the risk of developing cancer, in organs distant from the central nervous system, is lower among AD patients than in nondemented patients (Beard et al, 1996;Roe et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

High sensitivity to carcinogens in the brain of a mouse model of Alzheimer's disease

et al. 2010

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Cancer and Alzheimer's disease (AD) are commonly found among elderly patients. Chronic inflammation is the characteristic of both diseases. Amyloid-b peptide is the main inducer of inflammation in AD. Moreover, chronic inflammation promotes cancer, suggesting that AD patients may be more prone to develop cancer than nondemented people. To test this hypothesis, we injected the carcinogen 20-methylcholanthrene in the brain of transgenic mice overexpressing the mutant forms of amyloid precursor protein (APP) and presenilin 1 (PS1), as a model of AD, and their wild-type (WT) littermates. Mutant mice developed tumors faster and with higher incidence than their WT counterparts. Expression of the inflammatory markers interleukin (IL)-1a, IL-1b, IL-6, IP-10 and tumor necrosis factor-a (TNF-a) was measured in AD and WT mice of 3 and 12 months of age that had not been exposed to the carcinogen. These cytokines were elevated in older AD mice, indicating the existence of a highly inflammatory milieu in these animals. We also found elevated expression of a mutated form of p53 in older AD mice, suggesting an alternative mechanism for the predisposition of AD brains to develop brain tumors. Clinical studies reporting comorbidity of AD and brain cancer are needed to understand whether our observations hold true for humans.

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Comorbidity and clinical features in elderly patients with dementia: Differences according to dementia severity

Abstract: Important comorbidity conditions are common in elderly individuals with dementia. The patients with more severe dementia had poor functional status and higher frequency of neuroleptic use. Medical comorbidities should be taken into account in the management of patients with dementia.

Cited by 57 publications

References 27 publications

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

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

Comorbidity and dementia: A nationwide survey in Taiwan

High sensitivity to carcinogens in the brain of a mouse model of Alzheimer's disease

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