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.

H. Aguero-Torres , L. Fratiglioni and B. Winblad (1998). Natural history of Alzheimer's disease and other dementias: review of the literature in the light of the findings from the Kungsholmen Project. International Journal of Geriatric Psychiatry, 13, 755766.

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.

I. Boksay , E. Boksay , B. Reisberg , C. Torossian and M. Krishnamurthy (2005). Alzheimer's disease and medical disease conditions: a prospective cohort study. Journal of the American Geriatrics Society, 53, 22352236.

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.

G. Casella and R. L. Berger (2002). Statistical Inference, Second Edition. Pacific Grove, CA: Duxbury Press.

C. M. Callahan (2011). Implementing dementia care models in primary care settings: the Aging Brain Care Medical Home. Aging & Mental Health, 15, 512. doi: 10.1080/13607861003801052.

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 (2007). Geriatric care management for low-income seniors: a randomized controlled trial. JAMA, 298, 26232633. doi: 10.1001/jama.298.22.2623.

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.

P. M. Doraiswamy , J. Leon , J. L. Cummings , D. Marin and P. J. Neumann (2002). Prevalence and impact of medical comorbidity in Alzheimer's disease. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 57, M173M177.

M. F. Folstein , S. E. Folstein and P. R. McHugh (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research, 12, 189198.

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.

C. P. Hughes , L. Berg , W. L. Danziger , L. A. Coben and R. L. Martin (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566572.

C. Kawas , J. Segal , W. F. Stewart , M. Corrada and L. J. Thal (1994). A validation study of the dementia questionnaire. Archives of Neurology, 51, 901906.

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

T. C. Kuo , Y. Zhao , S. Weir , M. S. Kramer and A. S. Ash (2008). Implications of comorbidity on costs for patients with Alzheimer disease. Medical Care, 46, 839846.

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 (1999). The General Medical Health Rating: a bedside global rating of medical comorbidity in patients with dementia. Journal of the American Geriatrics Society, 47, 487491.

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.

E. L. Teng and H. C. Chui (1987). The Modified Mini-Mental State (3MS) Examination. Journal of Clinical Psychiatry, 48, 314318.

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

J.T. Tschanz , K.A. Welsh-Bohmer , B.L. Plassman , M.C. Norton , B.W. Wyse and J.C. Breitner (2002). An adaptation of the modified Mini-Mental State Examination: analysis of demographic influences and normative data: the Cache County study. Neuropsychology, Neuropsychiatry, and Behavioral Neurology, 15, 2838.

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.

B. G. Vickrey (2006). The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Annals of Internal Medicine, 145, 713726.

R. S. Wilson (2004). Education and the course of cognitive decline in Alzheimer disease. Neurology, 63, 11981202.

S. X. Xie , D. C. Ewbank , J. Chittams , J. H. Karlawish , S. E. Arnold and C. M. Clark (2009). Rate of decline in Alzheimer disease measured by a dementia severity rating scale. Alzheimer Disease and Associated Disorders, 23, 268274. doi: 10.1097/WAD.0b013e318194a324.

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: