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Effects of general medical health on Alzheimer's progression: the Cache County Dementia Progression Study

Year: 2012
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Several observational studies have suggested a link between health status and rate of decline among individuals with Alzheimer's disease (AD). We sought to quantify the relationship in a population-based study of incident AD, and to compare global comorbidity ratings to counts of comorbid conditions and medications as predictors of AD progression. METHODS: This was a case-only cohort study arising from a population-based longitudinal study of memory and aging, in Cache County, Utah. Participants comprised 335 individuals with incident AD followed for up to 11 years. Patient descriptors included sex, age, education, dementia duration at baseline, and APOE genotype. Measures of health status made at each visit included the General Medical Health Rating (GMHR), number of comorbid medical conditions, and number of non-psychiatric medications. Dementia outcomes included the Mini-Mental State Examination (MMSE), Clinical Dementia Rating - sum of boxes (CDR-sb), and the Neuropsychiatric Inventory (NPI). RESULTS: Health status tended to fluctuate over time within individuals. None of the baseline medical variables (GMHR, comorbidities, and non-psychiatric medications) was associated with differences in rates of decline in longitudinal linear mixed effects models. Over time, low GMHR ratings, but not comorbidities or medications, were associated with poorer outcomes (MMSE: β = -1.07 p = 0.01; CDR-sb: β = 1.79 p < 0.001; NPI: β = 4.57 p = 0.01). CONCLUSIONS: Given that time-varying GMHR, but not baseline GMHR, was associated with the outcomes, it seems likely that there is a dynamic relationship between medical and cognitive health. GMHR is a more sensitive measure of health than simple counts of comorbidities or medications. Since health status is a potentially modifiable risk factor, further study is warranted.
DOI: 10.1017/s104161021200049x
Authors: Jeannie-Marie S. Leoutsakos, Dingfen Han, Michelle M. Mielke, Sarah N. Forrester, JoAnn T. Tschanz, Chris D. Corcoran, Robert C. Green, Maria C. Norton, Kathleen A. Welsh-Bohmer, Constantine G. Lyketsos
Institutions: Johns Hopkins University, Johns Hopkins Medicine, Utah State University, Brigham and Women's Hospital, Harvard University, Duke University
Language: English
Field: Medicine
Open Access status: gold
Estimated APC paid: $3,500
Funders: National Institutes of Health, Centers for Disease Control and Prevention, National Institute on Aging, National Institute of Mental Health, National Human Genome Research Institute, National Institute of Environmental Health Sciences
Awards: G1004838280, Lifespan Stressors and Alzheimer's Disease: The Cache County Study, Dietary patterns, cognition and Alzheimer's Disease: the Cache County Study, Risk Evaluation and Education for Alzheimer's Disease (REVEAL IV), G2306943636, Longitudinal Study of Lipids and APOE in the Development of AD and AD Pathology, ADCC Genomic Medicine Approach to MCI and Dementia, Epidemiology of Dementia in Cache County, Utah, MATERNAL METABOLIC DISORDERS AND THE PREVENTION OF ORAL CLEFT BIRTH DEFECTS, Prenatal and Neonatal Biologic Markers for Autism, Citalopram Treatment for Agitation in Alzheimer Dementia, G5652044674, Progression of Dementia: A Population Study, THE CACHE COUNTY FAMILY BASED COHORT STUDY ON AGING, G6380718740, Characterizing and Communicating Genetic Risk for Alzheimer's Disease, Johns Hopkins Alzheimer's Disease Research Center, Boston University Alzheimer's Disease Center, Geriatric Depression: PET Studies of Pathophysiology and Treatment Response, Intracranial Atherosclerosis and predictors of Post-CABG Depression, G848997788, Oral Glucose Tolerance Test for Alzheimer's Disease Biomarker Development, Research Training in Age-Related Cognitive Disorders, G955521001
OpenAlex ID: W2109710950
FWCI: 3.427
Cites: 47
Cited by: 46
Related to: 10