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      The Influence of Multimorbidity on Clinical Progression of Dementia in a Population-Based Cohort

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          Abstract

          Introduction

          Co-occurrence with other chronic diseases may influence the progression of dementia, especially in case of multiple chronic diseases. We aimed to verify whether multimorbidity influenced cognitive and daily functioning during nine years after dementia diagnosis compared with the influence in persons without dementia.

          Methods

          In the Kungsholmen Project, a population-based cohort study, we followed 310 persons with incident dementia longitudinally. We compared their trajectories with those of 679 persons without dementia. Progression was studied for cognition and activities of daily life (ADLs), measured by MMSE and Katz Index respectively. The effect of multimorbidity and its interaction with dementia status was studied using individual growth models.

          Results

          The mean (SD) follow-up time was 4.7 (2.3) years. As expected, dementia related to both the decline in cognitive and daily functioning. Irrespective of dementia status, persons with more diseases had significantly worse baseline daily functioning. In dementia patients having more diseases also related to a significantly faster decline in daily functioning. Due to the combination of lower functioning in ADLs at baseline and faster decline, dementia patients with multimorbidity were about one to two years ahead of the decline of dementia patients without any co-morbidity. In persons without dementia, no significant decline in ADLs over time was present, nor was multimorbidity related to the decline rate. Cognitive decline measured with MMSE remained unrelated to the number of diseases present at baseline.

          Conclusion

          Multimorbidity was related to baseline daily function in both persons with and without dementia, and with accelerated decline in people with dementia but not in non-demented individuals. No relationship of multimorbidity with cognitive functioning was established. These findings imply a strong interconnection between physical and mental health, where the greatest disablement occurs when both somatic and mental disorders are present.

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          Most cited references15

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          Association of muscle strength with the risk of Alzheimer disease and the rate of cognitive decline in community-dwelling older persons.

          Joseph Boyle, David Bennett, Sue E. Leurgans … (2009)
          Loss of muscle strength is common and is associated with various adverse health outcomes in old age, but few studies have examined the association of muscle strength with the risk of Alzheimer disease (AD) or mild cognitive impairment (MCI). To test the hypothesis that muscle strength is associated with incident AD and MCI. Prospective observational cohort study. Retirement communities across the Chicago, Illinois, metropolitan area. More than 900 community-based older persons without dementia at the baseline evaluation and in whom strength was measured in 9 muscle groups in arms and legs, and in the axial muscles and summarized into a composite measure of muscle strength. Incident AD and MCI and the rate of change in global cognitive function. During a mean follow-up of 3.6 years, 138 persons developed AD. In a proportional hazards model adjusted for age, sex, and education status, each 1-U increase in muscle strength at baseline was associated with about a 43% decrease in the risk of AD (hazard ratio, 0.57; 95% confidence interval, 0.41-0.79). The association of muscle strength with AD persisted after adjustment for several covariates, including body mass index, physical activity, pulmonary function, vascular risk factors, vascular diseases, and apolipoprotein E4 status. In a mixed-effects model adjusted for age, sex, education status, and baseline level of global cognition, increased muscle strength was associated with a slower rate of decline in global cognitive function (P < .001). Muscle strength was associated with a decreased risk of MCI, the precursor to AD (hazard ratio, 0.67; 95% confidence interval, 0.54-0.84). These findings suggest a link between muscle strength, AD, and cognitive decline in older persons.
          Article 0 comments Cited 140 times – based on 0 reviews     Review now
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            Patterns of chronic multimorbidity in the elderly population.

            Laura Fratiglioni, Debora Rizzuto, Xin-Chao Wang … (2009)
            To describe patterns of comorbidity and multimorbidity in elderly people. A community-based survey. Data were gathered from the Kungsholmen Project, a urban, community-based prospective cohort in Sweden. Adults aged 77 and older living in the community and in institutions of the geographically defined Kungsholmen area of Stockholm (N=1,099). Diagnoses based on physicians' examinations and supported by hospital records, drug use, and blood samples. Patterns of comorbidity and multimorbidity were evaluated using four analytical approaches: prevalence figures, conditional count, logistic regression models, and cluster analysis. Visual impairments and heart failure were the diseases with the highest comorbidity (mean 2.9 and 2.6 co-occurring conditions, respectively), whereas dementia had the lowest (mean 1.4 comorbidities). Heart failure occurred rarely without any comorbidity (0.4%). The observed prevalence of comorbid pairs of conditions exceeded the expected prevalence for several circulatory diseases and for dementia and depression. Logistic regression analyses detected similar comorbid pairs. The cluster analysis revealed five clusters. Two clusters included vascular conditions (circulatory and cardiopulmonary clusters), and another included mental diseases along with musculoskeletal disorders. The last two clusters included only one major disease each (diabetes mellitus and malignancy) together with their most common consequences (visual impairment and anemia, respectively). In persons with multimorbidity, there exists co-occurrence of diseases beyond chance, which clinicians need to take into account in their daily practice. Some pathological mechanisms behind the identified clusters are well known; others need further clarification to identify possible preventative strategies.
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              The preclinical phase of alzheimer disease: A 22-year prospective study of the Framingham Cohort.

              R D'Agostino, Steven P Wolf, Alexa S Beiser … (2000)
              To relate performance on tests of cognitive ability to the subsequent development of probable Alzheimer disease (pAD) and to identify the pattern of earliest changes in cognitive functioning associated with a diagnosis of pAD. From May 1975 to November 1979, a screening neuropsychological battery was administered to Framingham Study participants. They were followed up prospectively for 22 years and examined at least every 2 years for the development of pAD. A community-based center for epidemiological research. Subjects were 1076 participants of the Framingham Study aged 65 to 94 years who were free of dementia and stroke at baseline (initial) neuropsychological testing. Presence or absence of pAD during a 22-year surveillance period was related to test performance at initial neuropsychological testing. Lower scores for measures of new learning, recall, retention, and abstract reasoning obtained during a dementia-free period were associated with the development of pAD. Lower scores for measures of abstract reasoning and retention predicted pAD after a dementia-free period of 10 years. The "preclinical phase" of detectable lowering of cognitive functioning precedes the appearance of pAD by many years. Measures of retention of information and abstract reasoning are among the strongest predictors of pAD when the interval between initial assessment and the development of pAD is long. Arch Neurol. 2000.
              Article 0 comments Cited 88 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                M. Maria Glymour: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2013
                Publication date (Electronic): 30 December 2013
                Volume: 8
                Issue: 12
                Electronic Location Identifier: e84014
                Affiliations
                [1 ]Department of Geriatric Medicine/Radboud Alzheimer Centre, Radboud University Medical Centre, Nijmegen, The Netherlands
                [2 ]Department of Medical and Surgery Sciences, University of Brescia, Brescia, Italy
                [3 ]Aging Research Center/Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
                [4 ]Department of Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
                University of California, San Francisco, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: RM SA MK LF. Performed the experiments: RM AM DR. Analyzed the data: RM. Wrote the paper: RM. Statistical advices: ST. Interpretation of the data/results: RM AM DR MK SA LF. Contributed to drafting of the manuscript: AM DR ST SA MK LF. Read and approved the final manuscript: RM AM DR ST MK SA LF.

                Article
                Publisher ID: PONE-D-13-00970
                DOI: 10.1371/journal.pone.0084014
                PMC ID: 3875493
                PubMed ID: 24386324
                SO-VID: 2a19fa98-1547-4506-b85e-f3cbc845e048
                Copyright statement: Copyright @ 2013
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 31 December 2012
                Date accepted : 17 November 2013
                Page count
                Pages: 10
                Funding
                This work was supported by a Rubicon Travel grant, Netherlands Organisation for Scientific Research (825.08.008) to René Melis ( http://www.nwo.nl/nwohome.nsf/pages/NWOP_6H2G7R_Eng). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Biology
                Subject: Population Biology
                Subject: Epidemiology
                Subject: Epidemiology of Aging
                Subject: Medicine
                Subject: Clinical Research Design
                Subject: Cohort Studies
                Subject: Epidemiology
                Subject: Epidemiology
                Subject: Clinical Epidemiology
                Subject: Epidemiology of Aging
                Subject: Geriatrics
                Subject: Mental Health
                Subject: Psychiatry
                Subject: Dementia
                Subject: Neurology
                Subject: Dementia

                ScienceOpen disciplines: Uncategorized
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                ScienceOpen disciplines: Uncategorized

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