title: Comorbidity and dementia: a scoping review of the literature.
abstract: BACKGROUND
  Evidence suggests that amongst people with dementia there is a high prevalence of comorbid medical conditions and related complaints. The presence of dementia may complicate clinical care for other conditions and undermine a patient's ability to manage a chronic condition. The aim of this study was to scope the extent, range and nature of research activity around dementia and comorbidity.
  
  
  METHODS
  We undertook a scoping review including all types of research relating to the prevalence of comorbidities in people with dementia; current systems, structures and other issues relating to service organisation and delivery; patient and carer experiences; and the experiences and attitudes of service providers. We searched AMED, Cochrane Library, CINAHL, PubMed, NHS Evidence, Scopus, Google Scholar (searched 2012, Pubmed updated 2013), checked reference lists and performed citation searches on PubMed and Google Scholar (ongoing to February 2014).
  
  
  RESULTS
  We included 54 primary studies, eight reviews and three guidelines. Much of the available literature relates to the prevalence of comorbidities in people with dementia or issues around quality of care. Less is known about service organisation and delivery or the views and experiences of people with dementia and their family carers. There is some evidence that people with dementia did not have the same access to treatment and monitoring for conditions such as visual impairment and diabetes as those with similar comorbidities but without dementia.
  
  
  CONCLUSIONS
  The prevalence of comorbid conditions in people with dementia is high. Whilst current evidence suggests that people with dementia may have poorer access to services the reasons for this are not clear. There is a need for more research looking at the ways in which having dementia impacts on clinical care for other conditions and how the process of care and different services are adapting to the needs of people with dementia and comorbidity. People with dementia should be included in the debate about the management of comorbidities in older populations and there needs to be greater consideration given to including them in studies that focus on age-related healthcare issues.
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK. f.bunn@herts.ac.uk.
authors.forename: Frances
authors.initials: F
authors.lastname: Bunn
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK. a.burn3@herts.ac.uk.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Burn
authors.affiliation: Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK. c.goodman@herts.ac.uk.
authors.forename: Claire
authors.initials: C
authors.lastname: Goodman
authors.affiliation: Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK. g.rait@ucl.ac.uk.
authors.forename: Greta
authors.initials: G
authors.lastname: Rait
authors.affiliation: Department of Psychology, Institute of Psychiatry, King's College London, Guy's Hospital Campus, London, SE1 9RT, UK. sam.norton@kcl.ac.uk.
authors.forename: Sam
authors.initials: S
authors.lastname: Norton
authors.affiliation: Institute for Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK. a.l.robinson@newcastle.ac.uk.
authors.forename: Louise
authors.initials: L
authors.lastname: Robinson
authors.affiliation: South Essex Partnership Trust, Luton, UK. johan.shoeman@sept.nhs.net.
authors.forename: Johan
authors.initials: J
authors.lastname: Schoeman
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK. cb105@medschl.cam.ac.uk.
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
mesh_terms: D000368:Aged; D015897:Comorbidity; D003704:Dementia; D003924:Diabetes Mellitus, Type 2; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D020521:Stroke; D014786:Vision Disorders