The Role of Medical Comorbidities on the Risk for Severe Dementia, Institutionalization, and Death in Alzheimer\u27s Disease: A Population Study in Cache County, Utah

Alzheimer’s disease is a progressive disease that impairs cognitive and functional abilities. Without a cure, it is estimated there will be 81 million cases of Alzheimer’s disease by 2040. Life for the individual with Alzheimer’s disease, and their family, changes drastically when the affected individual experiences significant problems with memory, thinking, and ability to complete daily tasks. Some become so debilitated that they need to be placed in a nursing home for supportive care. Until a cure is discovered, it will be important to identify what can be done to help those with Alzheimer’s disease minimize time spent experiencing severe disability and maximize their quality of life. Medical conditions are of interest because they have been shown to impact the possibility of getting Alzheimer’s disease and it is thought they may influence how quickly an individual progresses to a state of severe disability. The participants in this study were enrolled into the Cache County Dementia Progression Study within a few years of the onset of Alzheimer’s disease. Along with their caregivers, the participants were followed for several years until they either decided they wanted to stop participating, they moved away, passed away, or the study was complated in 2013. Each participant was seen as close to every 6 months as possible. At each visit the participants completed tests that would measure how well their memory and thinking abilities were and how well they could complete everyday tasks. The medical conditions of hypertension, congestive heart failure, stroke, the number of prescription medications being used, and scores from two rating scales of physical health status (General Medical Health Rating [GMHR] and the Charlson Comorbidity Index), were studied to see if they predicted how fast a participant would be classified as having severe dementia, be placed in a nursing home, or pass away. Worse ratings on the GMHR, history of congestive heart failure, and number of prescription medications were associated with progression to severe dementia. Number of prescription medications was also associated with nursing home placement. Worse ratings on the GMHR, stroke, and number of prescription medications were also associated with death. These findings are important because they contribute to a better understanding of how certain medical conditions and general medical wellness can potentially help slow the progression of Alzheimer’s disease. Knowing this information may inform research directed to discover the important factors in understanding how medical conditions and overall medical wellness can help maximize the overall functioning of persons with Alzheimer’s disease and potentially delay the onset of severe disability and institutionalization