title: 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.
abstract: 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.
authors.affiliation: 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
authors.forename: Constantine G
authors.initials: CG
authors.lastname: Lyketsos
authors.forename: Leslie
authors.initials: L
authors.lastname: Toone
authors.forename: JoAnn
authors.initials: J
authors.lastname: Tschanz
authors.forename: Peter V
authors.initials: PV
authors.lastname: Rabins
authors.forename: Martin
authors.initials: M
authors.lastname: Steinberg
authors.forename: Chiadi U
authors.initials: CU
authors.lastname: Onyike
authors.forename: Christopher
authors.initials: C
authors.lastname: Corcoran
authors.forename: Maria
authors.initials: M
authors.lastname: Norton
authors.forename: Peter
authors.initials: P
authors.lastname: Zandi
authors.forename: John C S
authors.initials: JC
authors.lastname: Breitner
authors.forename: Kathleen
authors.initials: K
authors.lastname: Welsh-Bohmer
authors.forename: James
authors.initials: J
authors.lastname: Anthony
authors.forename: Truls
authors.initials: T
authors.lastname: Østbye
authors.forename: Erin
authors.initials: E
authors.lastname: Bigler
authors.forename: Carl
authors.initials: C
authors.lastname: Pieper
authors.forename: James
authors.initials: J
authors.lastname: Burke
authors.forename: Brenda
authors.initials: B
authors.lastname: Plassman
authors.forename: Robert C
authors.initials: RC
authors.lastname: Green
authors.forename: David C
authors.initials: DC
authors.lastname: Steffens
authors.forename: Liz
authors.initials: L
authors.lastname: Klein
authors.forename: Carol
authors.initials: C
authors.lastname: Leslie
authors.forename: Jeannette J
authors.initials: JJ
authors.lastname: Townsend
authors.forename: Bonita W
authors.initials: BW
authors.lastname: Wyse
authors.forename: Ronald
authors.initials: R
authors.lastname: Munger
authors.forename: Michael
authors.initials: M
authors.lastname: Williams
mesh_terms: 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