Skip to main content
×
Home
    • Aa
    • Aa

Effects of general medical health on Alzheimer's progression: the Cache County Dementia Progression Study

  • Jeannie-Marie S. Leoutsakos (a1), Dingfen Han (a1), Michelle M. Mielke (a1), Sarah N. Forrester (a1), JoAnn T. Tschanz (a2) (a3), Chris D. Corcoran (a2) (a4), Robert C. Green (a5), Maria C. Norton (a2) (a3) (a6), Kathleen A. Welsh-Bohmer (a7) and Constantine G. Lyketsos (a1)...
Abstract
ABSTRACT

Background: Several observational studies have suggested a link between health status and rate of decline among individuals with Alzheimer's disease (AD). We sought to quantify the relationship in a population-based study of incident AD, and to compare global comorbidity ratings to counts of comorbid conditions and medications as predictors of AD progression.

Methods: This was a case-only cohort study arising from a population-based longitudinal study of memory and aging, in Cache County, Utah. Participants comprised 335 individuals with incident AD followed for up to 11 years. Patient descriptors included sex, age, education, dementia duration at baseline, and APOE genotype. Measures of health status made at each visit included the General Medical Health Rating (GMHR), number of comorbid medical conditions, and number of non-psychiatric medications. Dementia outcomes included the Mini-Mental State Examination (MMSE), Clinical Dementia Rating – sum of boxes (CDR-sb), and the Neuropsychiatric Inventory (NPI).

Results: Health status tended to fluctuate over time within individuals. None of the baseline medical variables (GMHR, comorbidities, and non-psychiatric medications) was associated with differences in rates of decline in longitudinal linear mixed effects models. Over time, low GMHR ratings, but not comorbidities or medications, were associated with poorer outcomes (MMSE: β = –1.07 p = 0.01; CDR-sb: β = 1.79 p < 0.001; NPI: β = 4.57 p = 0.01).

Conclusions: Given that time-varying GMHR, but not baseline GMHR, was associated with the outcomes, it seems likely that there is a dynamic relationship between medical and cognitive health. GMHR is a more sensitive measure of health than simple counts of comorbidities or medications. Since health status is a potentially modifiable risk factor, further study is warranted.

Copyright
Corresponding author
Correspondence should be addressed to: Dr. Jeannie-Marie S. Leoutsakos, PhD, MHS, Assistant Professor, Department of Psychiatry, Division of Geriatric Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Bayview – Alpha Commons Building 4th Floor, Baltimore, MD 21224, USA. Phone: +1 410-550-9884; Fax: +1 410-550-1407. Email: jeannie-marie@jhu.edu.
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

A. Agresti (1999). Modelling ordered categorical data: recent advances and future challenges. Statistics in Medicine, 18, 21912207.

Alzheimer's Association (2010). 2010 Alzheimer's disease facts and figures. Alzheimer's & Dementia, 6, 158194. doi: 10.1016/j.jalz.2010.01.009.

S. J. Bartels (2003). Improving system of care for older adults with mental illness in the United States. Findings and recommendations for the President's New Freedom Commission on Mental Health. American Journal of Geriatric Psychiatry, 11, 486497.

L. Bracco (2007). Pattern and progression of cognitive decline in Alzheimer's disease: role of premorbid intelligence and ApoE genotype. Dementia and Geriatric Cognitive Disorders, 24, 483491. doi: 10.1159/000111081.

J. C. Breitner (1999). APOE-epsilon4 count predicts age when prevalence of AD increases, then declines: the Cache County Study. Neurology, 53, 321331.

A. M. Brickman (2008). Measuring cerebral atrophy and white matter hyperintensity burden to predict the rate of cognitive decline in Alzheimer disease. Archives of Neurology, 65, 12021208. doi: 10.1001/archneur.65.9.1202.

K. Buerger (2005). Phosphorylated tau predicts rate of cognitive decline in MCI subjects: a comparative CSF study. Neurology, 65, 15021503. doi: 10.1212/01.wnl.0000183284.92920.f2.

E. Colantuoni , G. Surplus , A. Hackman , H. M. Arrighi and R. Brookmeyer (2010). Web-based application to project the burden of Alzheimer's disease. Alzheimer's & Dementia, 6, 425428. doi: 10.1016/j.jalz.2010.01.014.

F. Cortes (2008). Prognosis of Alzheimer's disease today: a two-year prospective study in 686 patients from the REAL-FR Study. Alzheimers & Dementia, 4, 2229.

S. R. Counsell , C. M. Callahan , W. Tu , T. E. Stump and G. W. Arling (2009). Cost analysis of the geriatric resources for assessment and care of elders care management intervention. Journal of the American Geriatrics Society, 57, 14201426.

J. L. Cummings (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, S10S16.

G. Dooneief , K. Marder , M. X. Tang and Y. Stern (1996). The Clinical Dementia Rating scale: community-based validation of “profound” and “terminal” stages. Neurology, 46, 17461749.

B. D. Hoyt , P. J. Massman , C. Schatschneider , N. Cooke and R. S. Doody (2005). Individual growth curve analysis of APOE epsilon 4-associated cognitive decline in Alzheimer disease. Archives of Neurology, 62, 454459. doi: 10.1001/archneur.62.3.454.

S. H. Jung and C. Ahn (2003). Sample size estimation for GEE method for comparing slopes in repeated measurements data. Statistics in Medicine, 22, 13051315.

M. I. Kester (2009). CSF biomarkers predict rate of cognitive decline in Alzheimer disease. Neurology, 73, 13531358. doi: 10.1212/WNL.0b013e3181bd8271.

N. Laird and J. H. Ware (1982). Random-effects models for longitudinal data. Biometrics, 38, 963974.

C. G. Lyketsos (2012). Prevention of unnecessary hospitalization for patients with dementia: the role of ambulatory care. JAMA, 307, 197198. doi: 10.1001/jama.2011.2005.

C. G. Lyketsos , M. Steinberg , J. T. Tschanz , M. C. Norton , D. C. Steffens and J. C. Breitner (2000). Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. American Journal of Psychiatry, 157, 708714.

C. G. Lyketsos (2006). Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia resulting from Alzheimer disease. American Journal of Geriatric Psychiatry, 14, 561572. doi:10.1097/01.JGP.0000221334.65330.55.

C. A. Martins , A. Oulhaj , de C. A. Jager and J. H. Williams (2005). APOE alleles predict the rate of cognitive decline in Alzheimer disease: a nonlinear model. Neurology, 65, 18881893.

G. McKhann , D. Drachman , M. Folstein , R. Katzman , D. Price and E. M. Stadlan (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology, 34, 939944.

M. M. Mielke (2007). Vascular factors predict rate of progression in Alzheimer disease. Neurology, 69, 18501858. doi: 10.1212/01.wnl.0000279520.59792.fe.

D. Mungas (2002). Volumetric MRI predicts rate of cognitive decline related to AD and cerebrovascular disease. Neurology, 59, 867873.

P. V. Rabins , C. G. Lyketsos and C. Steele (2006). Practical Dementia Care. New York: Oxford University Press.

M. Storandt , E. A. Grant , J. P. Miller and J. C. Morris (2002). Rates of progression in mild cognitive impairment and early Alzheimer's disease. Neurology, 59, 10341041.

J. T. Tschanz (2000). Dementia diagnoses from clinical and neuropsychological data compared: the Cache County study. Neurology, 54, 12901296.

J. T. Tschanz (2011). Progression of cognitive, functional, and neuropsychiatric symptom domains in a population cohort with Alzheimer dementia: the Cache County Dementia Progression Study. American Journal of Geriatric Psychiatry, 19, 532542. doi: 10.1097/JGP.0b013e3181faec23.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 3
Total number of PDF views: 15 *
Loading metrics...

Abstract views

Total abstract views: 148 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 25th March 2017. This data will be updated every 24 hours.