Dementia and co-occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence?
The challenges posed by people living with multiple chronic conditions are unique for people with dementia and other significant cognitive impairment. There have been recent calls to action to review the existing literature on co-occurring chronic conditions and dementia in order to better understand the effect of cognitive impairment on disease management, mobility, and mortality.



This systematic literature review searched PubMed databases through 2011 (updated in 2016) using key constructs of older adults, moderate-to-severe cognitive impairment (both diagnosed and undiagnosed dementia), and chronic conditions. Reviewers assessed papers for eligibility and extracted key data from each included manuscript. An independent expert panel rated the strength and quality of evidence and prioritized gaps for future study.



Four thousand thirty-three articles were identified, of which 147 met criteria for review. We found that moderate-to-severe cognitive impairment increased risks of mortality, was associated with prolonged institutional stays, and decreased function in persons with multiple chronic conditions. There was no relationship between significant cognitive impairment and use of cardiovascular or hypertensive medications for persons with these comorbidities. Prioritized areas for future research include hospitalizations, disease-specific outcomes, diabetes, chronic pain, cardiovascular disease, depression, falls, stroke, and multiple chronic conditions.



This review summarizes that living with significant cognitive impairment or dementia negatively impacts mortality, institutionalization, and functional outcomes for people living with multiple chronic conditions. Our findings suggest that chronic-disease management interventions will need to address co-occurring cognitive impairment. Copyright © 2017 John Wiley & Sons, Ltd.
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
Mark B
MB
Snowden
Health Promotion Research Center, University of Washington, Seattle, WA, USA.
Lesley E
LE
Steinman
Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Lucinda L
LL
Bryant
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
Monique M
MM
Cherrier
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Kurt J
KJ
Greenlund
College of Social Work, Hamilton College, University of South Carolina, Columbia, SC, USA.
Katherine H
KH
Leith
Division of Health Care Policy and Research, School of Medicine, University of Colorado and the Denver Veterans Affairs Medical Center, Denver, CO, USA.
Cari
C
Levy
UW School of Nursing, Northwest Research Group on Aging, Seattle, WA, USA.
Rebecca G
RG
Logsdon
Health Promotion Research Center, University of Washington, Seattle, WA, USA.
Catherine
C
Copeland
Health Promotion Research Center, University of Washington, Seattle, WA, USA.
Mia
M
Vogel
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, and Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Lynda A
LA
Anderson
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
David C
DC
Atkins
Betty Irene Moore School of Nursing, University of California, Davis, CA, USA.
Janice F
JF
Bell
Departments of Family Medicine, Epidemiology, and Global Health, School of Medicine and School of Public Health, University of Washington, Seattle, WA, USA.
Annette L
AL
Fitzpatrick
D000203:Activities of Daily Living; D002908:Chronic Disease; D060825:Cognitive Dysfunction; D015897:Comorbidity; D003704:Dementia / Q000401:mortality; D019317:Evidence-Based Medicine / Q000592:standards*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D007902:Length of Stay
aging; cognitive impairment; dementia; multiple chronic conditions; public health; systematic literature review