Multimorbidity and Risk of Mild Cognitive Impairment

Vassilaki, Maria; Aakre, Jeremiah A.; Ruth, H.; Kremers, Walter K.; Sauver, Jennifer L. St.; Mielke, Michelle M.; Geda, Yonas E.; Machulda, Mary M.; Knopman, David S.; Petersen, Ronald C.; Roberts, Rosebud O.

doi:10.1111/jgs.13612

Cited by 158 publications

(172 citation statements)

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“…1 Multimorbidity is becoming the norm among adults in primary care settings, 2 mandating the need to investigate not only the causes, but also the association with future health outcomes. Multimorbidity is associated with an increased risk for hospitalizations and increased length of stay, worsening quality of life and physical functioning, polypharmacy, mild cognitive impairment, 3 and depression, resulting in significant economic costs for the health care system. 2 Several of the common chronic conditions that contribute to multimorbidity are established risk factors for mild cognitive impairment (MCI) or dementia (e.g., vascular diseases, cerebrovascular disease, depression, or chronic obstructive pulmonary disease).…”

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confidence: 99%

“…2 Several of the common chronic conditions that contribute to multimorbidity are established risk factors for mild cognitive impairment (MCI) or dementia (e.g., vascular diseases, cerebrovascular disease, depression, or chronic obstructive pulmonary disease). [3][4][5][6][7][8] We hypothesized, therefore, that multimorbidity may also be associated with abnormal brain imaging findings that are characteristically present in persons with Alzheimer disease (AD) dementia, but this association has not been studied. Thus, the objective of this study was to determine the cross-sectional associations between multimorbidity and in vivo biomarkers of brain pathology (atrophy, increased amyloid accumulation, and reduced metabolism) assessed by MRI, METHODS Study population.…”

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confidence: 99%

“…Ascertainment of multimorbidity has been published. 3,12 Briefly, the diagnostic indices of the REP medical records linkage system were searched electronically for each participant to identify the ICD-9 codes for 19 chronic conditions 13 associated with any health care visit within 5 years before the first imaging (i.e., 5-year capture frame). 12 These conditions were proposed by the US Department of Health and Human Services in 2010 to study multimorbidity.…”

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confidence: 99%

“…A specific chronic condition was assigned to a participant if he or she received 2 ICD-9 codes for the given condition separated by more than 30 days within the 5-year capture frame. 3,12 Seventeen (of the 19) chronic conditions were captured in the study sample: hyperlipidemia, diabetes mellitus, hypertension, cardiac arrhythmias, coronary artery disease, stroke, congestive heart failure, cancer, asthma, depression, substance abuse disorders (drugs and alcohol), chronic obstructive pulmonary disease, chronic kidney disease, arthritis, osteoporosis, schizophrenia, and hepatitis. In addition, the 6 most common dyads (any combinations of 2 of the 17 chronic conditions) were identified in persons with multimorbidity.…”

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confidence: 99%

“…This is consistent with dyads previously found to be associated with risk of incident MCI in the MCSA cohort. 3 A second hypothesis is that the aggregate effect of multiple co-occurring chronic conditions on brain pathology may differ from the simple summation of their individual effects-as suggested for example by investigators 32 for the co-presence of multiple vascular risk factors and their aggregate effect on brain pathology. As such, the insight provided by the association of multiple co-occurring conditions (i.e., multimorbidity) with antemortem brain pathology is informative and relevant for early detection and intervention for those at increased risk of brain pathology.…”

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Multimorbidity and neuroimaging biomarkers among cognitively normal persons

et al. 2016

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Objective: To assess the cross-sectional association between multimorbidity and imaging biomarkers of brain pathology in the population-based Mayo Clinic Study of Aging (MCSA). Methods:The study consisted of 1,449 MCSA participants who were cognitively normal at the time of MRI. A subset of the participants also had 11 C-Pittsburgh compound B (n 5 689) and 18 fluorodeoxyglucose (n 5 688) PET scans available. Information on multimorbidity (defined as $2 chronic conditions) in the 5 years prior to the first imaging study was captured from the medical record using ICD-9 codes for chronic conditions and the Rochester Epidemiology Project medical records linkage system. The cross-sectional association of multimorbidity and imaging biomarkers was examined using logistic and linear regression models.Results: Among 1,449 cognitively normal participants (mean age 79 years; 50.9% men), 85.4% had multimorbidity ($2 chronic conditions). Multimorbidity and severe multimorbidity ($4 chronic conditions) were associated with abnormal Alzheimer disease (AD) signature meta-region of interest (meta-ROI) 18 Conclusions: Multimorbidity was associated with brain pathology through mechanisms independent of amyloid deposition and such neuronal injury and pathology was present before any symptomatic evidence of cognitive impairment. Longitudinal follow-up will provide insights into potential causal associations of multimorbidity with changes in brain pathology. Multimorbidity has a prevalence of 20%-30% in the general population, 1 and increases with age from 55% to 98% among persons older than 60 years.1 Multimorbidity is becoming the norm among adults in primary care settings, 2 mandating the need to investigate not only the causes, but also the association with future health outcomes. Multimorbidity is associated with an increased risk for hospitalizations and increased length of stay, worsening quality of life and physical functioning, polypharmacy, mild cognitive impairment, 3 and depression, resulting in significant economic costs for the health care system.2 Several of the common chronic conditions that contribute to multimorbidity are established risk factors for mild cognitive impairment (MCI) or dementia (e.g., vascular diseases, cerebrovascular disease, depression, or chronic obstructive pulmonary disease).3-8 We hypothesized, therefore, that multimorbidity may also be associated with abnormal brain imaging findings that are characteristically present in persons with Alzheimer disease (AD) dementia, but this association has not been studied. Thus, the objective of this study was to determine the cross-sectional associations between multimorbidity From the Departments of Health Sciences Research

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Multimorbidity and neuroimaging biomarkers among cognitively normal persons

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Deprescribing Education vs Usual Care for Patients With Cognitive Impairment and Primary Care Clinicians

et al. 2022

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Key Points Question Can increasing awareness about deprescribing prior to primary care visits reduce the use of potentially inappropriate long-term medications for individuals with cognitive impairment? Findings In this pragmatic cluster randomized clinical trial of deprescribing education for 3012 older adults with cognitive impairment taking 5 or more medications and their primary care clinicians, patients from intervention clinics and control clinics were taking a similar mean number of medications (6.4 vs 6.5) at 6 months, and similar proportions of patients were taking 1 or more potentially inappropriate medications after 6 months. Meaning Educating patients and clinicians about deprescribing in primary care did not have an effect on the number of long-term medications or percentage of potentially inappropriate medications for older adults taking 5 or more long-term medications; findings suggest such interventions should target older adults taking relatively more medications.

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Evaluation of Amyloid Protective Factors and Alzheimer Disease Neurodegeneration Protective Factors in Elderly Individuals

et al. 2017

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IMPORTANCE While amyloid and neurodegeneration are viewed together as Alzheimer disease pathophysiology (ADP), the factors that influence amyloid and AD-pattern neurodegeneration may be considerably different. Protection from these ADP factors may be important for aging without significant ADP. OBJECTIVE To identify the combined and independent protective factors for amyloid and AD-pattern neurodegeneration in a population-based sample and to test the hypothesis that "exceptional agers" with advanced ages do not have significant ADP because they have protective factors for amyloid and neurodegeneration. DESIGN, SETTING, AND PARTICIPANTS This cohort study conducted a prospective analysis of 942 elderly individuals (70-Ն90 years) with magnetic resonance imaging and Pittsburgh compound B-positron emission tomography scans enrolled in the Mayo Clinic Study of Aging, a longitudinal population-based study of cognitive aging in Olmsted County, Minnesota. We operationalized "exceptional aging" without ADP by considering individuals 85 years or older to be without significant evidence of ADP. MAIN OUTCOMES AND MEASURES We evaluated predictors including demographics, APOE, intellectual enrichment, midlife risk factors (physical inactivity, obesity, smoking, diabetes, hypertension, and dyslipidemia), and the total number of late-life cardiac and metabolic conditions. We used multivariate linear regression models to identify the combined and independent protective factors for amyloid and AD-pattern neurodegeneration. Using a subsample of the cohort 85 years of age or older, we computed Cohen d-based effect size estimations to compare the quantitative strength of each predictor variable in their contribution with exceptional aging without ADP. RESULTS The study participants included 423 (45%) women and the average age of participants was 79.7 (5.9) years. Apart from demographics and the APOE genotype, only midlife dyslipidemia was associated with amyloid deposition. Obesity, smoking, diabetes, hypertension, and cardiac and metabolic conditions, but not intellectual enrichment, were associated with greater AD-pattern neurodegeneration. In the 85 years or older cohort, the Cohen d results showed small to moderate effects (effect sizes > 0.2) of several variables except job score and midlife hypertension in predicting exceptional aging without ADP. CONCLUSIONS AND RELEVANCE The protective factors that influence amyloid and AD-pattern neurodegeneration are different. "Exceptional aging" without ADP may be possible with a greater number of protective factors across the lifespan but warrants further investigation.

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Multimorbidity and Risk of Mild Cognitive Impairment

Cited by 158 publications

References 53 publications

Multimorbidity and neuroimaging biomarkers among cognitively normal persons

Multimorbidity and neuroimaging biomarkers among cognitively normal persons

Deprescribing Education vs Usual Care for Patients With Cognitive Impairment and Primary Care Clinicians

Evaluation of Amyloid Protective Factors and Alzheimer Disease Neurodegeneration Protective Factors in Elderly Individuals

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