Year: 2012
Type: article
Abstract: The National Alzheimer's Planning Act calls for comprehensive approaches to improving medical care for patients with dementia and the chronic conditions that often coexist with it (multimorbidity). This study aims to explore the main components of dementia multimorbidity and their inter-relationships in a large national database, in which dementia diagnoses are standardized and neuropsychiatric symptoms NPS and common chronic medical conditions are systematically reported. Exploratory cross-sectional analysis of baseline UDS data on persons with dementia, aged 65+, from the National Alzheimer's Coordinating Center data repository [U01 AG016976]. Sample: 3,768 adults with single or multiple etiologies of dementia, with Alzheimer disease (AD) as the reference diagnosis for comparative analyses; other primary dementia diagnoses included were dementia with Lewy bodies (DLB) and behavioral-variant frontotemporal dementia (bvFTD). NPS were derived from the Neuropsychiatric Inventory (NPI-Q). Comorbid conditions, identified from the UDS checklist, included cardiovascular disease, cerebrovascular disease and diabetes. Descriptive statistics depicted prevalence of NPS by dementia type, severity and number of target comorbidities. Linear regression with robust standard errors examined associations between dementia diagnosis, number of comorbidities and NPI-Q score (presence x severity). Interaction terms were introduced to test whether specific comorbid conditions influenced association between dementia diagnosis and NPI-Q. The prevalence of individual NPS varied from 5 percent for elation to 51 percent for apathy, and the total NPI score was stage-dependent for all dementia diagnoses. 2,099 subjects had no target comorbid conditions; 1,266 had 1 and 403 had ≥ 2. The number of comorbid conditions was not associated with NPI-Q score (P = 0.25), but, after adjustment for covariates, the presence of diabetes mitigated the differences in NPI-Q score between bvFTD and AD observed in persons without diabetes (p for interaction = 0.03). NPI-Q score differences between DLB and AD were not similarly affected. This is one of few studies to explore multimorbidity in patients with research-quality dementia diagnoses. The data provide evidence that all dementia multimorbidity components should be accounted for when making treatment and prognostic decisions, educating patients and their family caregivers and organizing health care systems for optimal management.
Source: Alzheimer s & Dementia
Authors: Tatiana Sadak, Jodie Katon, Soo Borson
Institution: University of Washington
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2024323438