title: Comorbidity and the rate of cognitive decline in patients with Alzheimer dementia.
abstract: OBJECTIVE
  This study aimed to investigate the impact of comorbidity on cognitive and functional decline in patients with Alzheimer dementia (AD).
  
  
  METHODS
  One hundred and two AD outpatients examined at the Psychiatry Department of the CF2 Polyclinic in Bucharest, Romania and re-evaluated after 2 years. Comorbidity was rated using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G).
  
  
  RESULTS
  Baseline mean age (SD) was 75.4 (8.2) years, median CDR (range) was 2 (1-3), and mean MMSE (SD) 14.2 (4.9). MMSE declined to 11.2 (4.8) during follow-up. Baseline mean total CIRS-G score (SD) was 13.8 (5.4), median number of endorsed categories (range) was 8 (1-14), and mean severity index (SD) 1.9 (0.4). Main comorbidity areas were cardiovascular, ear, nose and throat, genitourinary, musculoskeletal/integument, and neurological. Severity of comorbidity increased with dementia severity (p <0.001). Baseline comorbidity was related to increased rate of cognitive decline; truncated regression coefficients (p-values) were 0.01 (0.02) for CIRS-G total score, and 0.15 (0.006) for severity index (controlled for age, sex, education, and AD treatment). Faster cognitive decline was associated with faster functional decline: OR (95% CI) was 5.2 (1.9-13.6) for increased rate of ADL change and 3.8 (1.0-14.1) for increased rate of IADL change (controlled for age, sex, education, AD medication, and comorbidity). Comorbidity tended to increase functional decline; however, the associations were not statistically significant.
  
  
  CONCLUSIONS
  In this group of patients with AD, comorbidity increased the rate of cognitive decline. Considering comorbidity instead of focusing on separate conditions may be more helpful in managing AD.
authors.affiliation: Department of Neurology, University of Eastern Finland, Kuopio, Finland. alina.solomon@uef.fi
authors.forename: Alina
authors.initials: A
authors.lastname: Solomon
authors.forename: Letitia
authors.initials: L
authors.lastname: Dobranici
authors.forename: Ingemar
authors.initials: I
authors.lastname: Kåreholt
authors.forename: Cătălina
authors.initials: C
authors.lastname: Tudose
authors.forename: Mircea
authors.initials: M
authors.lastname: Lăzărescu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000453:epidemiology / Q000523:psychology*; D003072:Cognition Disorders / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012383:Romania / Q000453:epidemiology; D012720:Severity of Illness Index