Population-based study of medical comorbidity in early dementia and "cognitive impairment, no dementia (CIND)": association with functional and cognitive impairment: The Cache County Study.
OBJECTIVE
Authors investigated medical comorbidity in persons with dementia and "Cognitive Impairment, No Dementia" (CIND).


METHODS
The Cache County Study is an ongoing population-based study of the epidemiology of dementia, the risk factors for conversion from CIND to dementia, and the progression of dementia. As part of the study's first incidence wave, persons with dementia (N=149), CIND (N=225), or without cognitive impairment (N=321) were identified and studied. Participants received comprehensive clinical evaluations and were rated on the General Medical Health Rating (GMHR), a global measure of seriousness of medical comorbidity. Participants and informants also completed the Mini-Mental State Exam and provided self-report information about comorbid medical conditions and functioning in activities of daily living.


RESULTS
There were few differences in number or type of comorbid medical conditions between persons with CIND and dementia, but persons with dementia were prescribed more medications. Stroke was more common in dementia participants, but other illnesses common in old age were not significantly different across cognitive groups. Medical comorbidity was more serious in both dementia and CIND, such that both groups were less likely to have "little to no" comorbidity. Seriousness of medical comorbidity was significantly associated with worse day-to-day functioning and cognition.


CONCLUSIONS
Persons with CIND and dementia have more serious medical comorbidity than comparable persons without cognitive impairment. This comorbidity may play a role in the progression of CIND and dementia. Future studies should investigate the role of medical comorbidity and its treatment on dementia onset or progression, as well as the mechanisms mediating its neuropathologic effects.
Lyketsos
Constantine G
CG
Division of Geriatric Psychiatry and Neuropsychiatry, Dept. of Psychiatry and Behavioral Sciences, School of Medicine, The Johns Hopkins University, Johns Hopkins Hospital, Baltimore, MD 21287, USA. kostas@jhmi.edu
Toone
Leslie
L
Tschanz
JoAnn
J
Rabins
Peter V
PV
Steinberg
Martin
M
Onyike
Chiadi U
CU
Corcoran
Christopher
C
Norton
Maria
M
Zandi
Peter
P
Breitner
John C S
JC
Welsh-Bohmer
Kathleen
K
Anthony
James
J
Østbye
Truls
T
Bigler
Erin
E
Pieper
Carl
C
Burke
James
J
Plassman
Brenda
B
Green
Robert C
RC
Steffens
David C
DC
Klein
Liz
L
Leslie
Carol
C
Townsend
Jeannette J
JJ
Wyse
Bonita W
BW
Munger
Ronald
R
Williams
Michael
M
D000203:Activities of Daily Living / Q000145:classification*; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology*; D000704:Analysis of Variance; D016022:Case-Control Studies; D002908:Chronic Disease / Q000453:epidemiology*; D003072:Cognition Disorders / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D011159:Population Surveillance; D012016:Reference Values; D012307:Risk Factors