Comorbidities Common and Disabling in Alzheimer’s and Dementia Patients, UK Study Reports

People with dementia, including those with Alzheimer’s disease, often are also living with one or more other chronic diseases  that significantly impact their quality of life, according to a new study.

The study, “The impact of comorbidity on the quality of life of people with dementia: findings from the IDEAL study,” was published in the journal Age and Ageing.

The existence of multiple chronic diseases in a person, called comorbidities, can influence degrees of disability and are associated with poorer health-related quality of life (HRQoL). But few studies have investigated how comorbidities — like diabetes, heart disease, or depression — impact HRQoL, and life quality in general, among dementia patients.

Researchers at the University of Exeter examined data on 1,547 people with dementia — of which 858, or 55 percent, had an Alzheimer’s diagnosis — who were enrolled in the “Improving the experience of Dementia and Enhancing Active Life (IDEAL)” cohort study in the U.K.

All provided information on their health status, specifically the impact of one or more of 23 comorbidities included in the Charlson comorbidity index (CCI), administered in a joint interview with the patient and, when available, a caregiver.

Diseases were categorized according to four levels of severity: no comorbidity, mild (one-to-two conditions), moderate (three-four), and severe (more than five comorbidities).

Patients were also asked to rate their quality of life — using a scale developed for people with dementia, called QoL in Alzheimer’s disease (QoL-AD) scale — both in relation to dementia and to their overall health.

“People with dementia living with additional health conditions are at greater risk of experiencing pain, mobility problems, anxiety and depression, and report poor quality of life. While multiple health condition are also common in older people without dementia, a diagnosis of dementia can mean that other health conditions don’t always get the attention they deserve,” Linda Clare, a professor at the University of Exeter, and the study’s lead author, said in a press release.

A majority of patients (52 percent, 757 people) reported having one to two conditions, with severe comorbidity — more than five chronic diseases — reported by 81 people or 5 percent of participants.

Hypertension (high blood pressure) was the most frequent comorbidity, affecting 38.7 percent of patients; it was followed by connective tissue disease (24.5 percent), depression (15.4 percent), diabetes (12.7  percent), and chronic pulmonary disease (12.5 percent).

The severity of comorbid conditions negatively affected both QoL-AD and HRQoL, compared with patients without multiple chronic diseases. Not surprisingly, those with severe comorbidity were comparatively six points lower in QoL-AD scores and 18 points lower in HRQoL scores.

Severe comorbidity was associated with higher risks of problems in mobility, self-care, limitations on daily activities, pain or discomfort, and anxiety or depression.

“[C]omorbidity is an important risk factor for poor health and global well-being in people with dementia,” the researchers wrote.

“With 800,000 people in the UK currently living with dementia, this study highlights the need for better care planning and support to deal with multiple conditions in a more integrated way. This will optimise quality of life for both people with dementia and their carers, and help people live independently for longer,” Clare added.

The IDEAL study is supported by the Alzheimer’s Society through £2 million (roughly $2.6 million) grant toward establishing for a Centre of Excellence in Dementia Care at Exeter. The society will continue its support until at least 2022.

“This adds solid research evidence to what people with dementia tell us about how other health conditions complicate their care, and the negative impact to their lives that can result from health services not taking a holistic approach,” said James Pickett, head of research for the Alzheimer’s Society.