Comorbidities of Alzheimer‘s disease – results of a multicentric observational COSMOS study in the Slovak Republic

Czech version

Authors: M. Minár ¹; J. Dragašek ²; I. Mátéffy ³; P. Valkovič ^1,4
Authors‘ workplace: II. neurologická klinika LF UK a UN Bratislava, Slovensko ¹; I. psychiatrická klinika LF UPJŠ Košice, Slovensko ²; Psychiatrická klinika SZU UN Bratislava, Slovensko ³; Ústav normálnej a patologickej fyziológie, Slovenská akadémia vied, Bratislava, Slovensko ⁴
Published in: Cesk Slov Neurol N 2020; 83(1): 95-99
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn202095

Alzheimerova demencia (AD) patrí medzi najviac invalidizujúce ochorenia prevažne staršej populácie. Dáta nasvedčujú, že pridružené komorbidity komplikujú diagnostiku aj liečbu a urýchľujú progresiu AD. Epidemiologické dáta zo strednej Európy chýbajú, preto cieľom projektu COSMOS bolo odhaliť prevalenciu psychiatrických a somatických komorbidít pacientov s AD v slovenskej populácii. V tejto multicentrickej prierezovej observačnej štúdii boli údaje o pacientoch s AD z celého Slovenska získané z 89 pracovísk pomocou on-line dotazníka, ktorý obsahoval demografické a klinické údaje, informácie o všetkých komorbiditách a ich vplyve na adherenciu a účinnosť terapie.

Overview

Aim: Alzheimer‘s disease (AD) is one of the most disabling conditions predominantly affecting an elderly population. Data suggest that comorbidities complicate both diagnosis and treatment and accelerate AD progression. Epidemiological data from the Central Europe are missing, therefore, the aim of the COSMOS project was to reveal the prevalence of psychiatric and somatic comorbidities among AD patients in the Slovak population.

Methods: In this multicenter, cross--sectional, observational study, data of AD patients from all Slovak regions (89 sites) were obtained using an online questionnaire. It contained demographic and clinical data, information about all comorbidities, and their impact on adherence and tratment efficacy.

Results: Out of all 494 patients, 94.53% had at least one somatic comorbidity, 80.16% had at least one psychiatric comorbidity. The number of both somatic (r_s = 0.120; P = 0.008) and psychiatric (r_s = 0.267; P < 0.001) comorbidities correlated with the severity of AD. The number of psychiatric comorbidities (b = –0.021; P = 0.025) and the severity of AD (b = –0.071; P < 0.001) predicted a worse therapy effect. Adherent patients were more likely to have effective therapy of dementia (OR 5.270; 95% CI 3.061–9.073; P < 0.001).

Conclusion: Comorbidities in AD have been shown to accelerate progression of underlying disease and complicate diagnosis and therapy. However, they represent the most modifiable factors of cognitive deterioration. Their active screening, early diagnosis and adequate therapy can improve patient’s adherence and, thus, make AD management more effective.

Keywords:

Alzheimer‘s disease – comorbidities – psychiatric – somatic – therapy – adherence

Sources

1. Gambassi G, Landi F, Lapane KL et al. Predictors of mortality in patients with Alzheimer’s disease living in nursing homes. J Neurol Neurosurg Psychiatry 1999; 67(1): 59–65. doi: 10.1136/ jnnp.67.1.59.

2. Doraiswamy PM, Leon J, Cummings JL et al. Prevalence and impact of medical comorbidity in Alzheimer’s disease. J Gerontol A Biol Sci Med Sci 2002; 57(3): M173–M177. doi: 10.1093/ gerona/ 57.3.m173

3. García-Alberca JM, Pablo Lara J, González-Barón S et al. Prevalence and comorbidity of neuropsychiatric symptoms in Alzheimer’s disease. Actas Esp Psiquiatr 2008; 36(5): 265–270.

4. Aubert L, Pichierri S, Hommet C et al. Association between comorbidity burden and rapid cognitive decline in individuals with mild to moderate Alzheimer’s disease. J Am Geriatr Soc 2015; 63(3): 543–547. doi: 10.1111/ jgs.13314.

5. Vogelgsang J, Wolff-Menzler C, Kis B et al. Cardiovascular and metabolic comorbidities in patients with Alzheimer’s disease and vascular dementia compared to a psychiatric control cohort. Psychogeriatrics 2018; 18(5): 393–401. doi: 10.1111/ psyg.12338.

6. Taylor DH, Schenkman M, Zhou J et al. The relative effect of Alzheimer’s disease and related dementias, disability, and comorbidities on cost of care for elderly persons. J Gerontol B Psychol Sci Soc Sci 2001; 56(5): S285–S293. doi: 10.1093/ geronb/ 56.5.s285.

7. Hill JW, Futterman R, Duttagupta S et al. Alzheimer’s disease and related dementias increase costs of comorbidities in managed Medicare. Neurology 2002; 58(1): 62–70. doi: 10.1212/ wnl.58.1.62.

8. Fereshtehnejad SM, Damangir S, Cermakova P et al. Comorbidity profile in dementia with Lewy bodies versus Alzheimer’s disease: a linkage study between the Swedish Dementia Registry and the Swedish National Patient Registry. Alzheimers Res Ther 2014; 6(5–8): 65. doi: 10.1186/ s13195-014-0065-2.

9. Koopmans RT, Ekkerink JL, Sirre LG et al. Multi-infarct dementia in nursing home patients; more comorbidity and shorter life expectancy than in Alzheimer’s disease. Ned Tijdsch Geneeskd 1992; 136(45): 2223–2227.

10. Šilhán D, Ibrahim I, Tintěra J et al. Magnetic resonance imaging showing parietal atrophy of the brain in late-onset Alzheimer’s disease. Cesk Slov Neurol N 2019; 82/ 115(1): 91–95. doi: 10.14735/ amcsnn201991.

11. Tractenberg RE, Weiner MF, Patterson MB et al. Comorbidity of psychopathological domains in community--dwelling persons with Alzheimer’s disease. J Geriatr Psychiatry Neurol 2003; 16(2): 94–99. doi: 10.1177/ 089198 8703016002006.

12. Kadlecová A, Laczó J, Vyhnálek M et al. Vztah deprese a rozeznávání emocí z výrazu tváře u pacientů s mírnou kognitivní poruchou. Cesk Slov Neurol N 2013; 76/ 109(1): 52–55.

13. Berger AK, Fratiglioni L, Winblad B et al. Alzheimer’s disease and depression: preclinical comorbidity effects on cognitive functioning. Cortex 2005; 41(4): 603–612.

14. Brzecka A, Leszek J, Ashraf et al. Sleep disorders associated with Alzheimer’s disease: a perspective. Front Neurosci 2018; 12: 330. doi: 10.3389/ fnins.2018.00330.

15. Breitve MH, Hynninen MJ, Brønnick K et al. A longitudinal study of anxiety and cognitive decline in dementia with Lewy bodies and Alzheimer’s disease. Alzheimers Res Ther 2016; 8(1): 3. doi: 10.1186/ s13195-016-0171-4.

16. Wang JH, Wu YJ, Tee BL et al. Medical comorbidity in Alzheimer’s disease: a nested case-control study. J Alzheimers Dis 2018; 63(2): 773–781. doi: 10.3233/ JAD-170786.

17. Eldholm RS, Persson K, Barca ML et al. Association between vascular comorbidity and progression of Alzheimer’s disease: a two-year observational study in Norwegian memory clinics. BMC Geriatr 2018; 18(1): 120. doi: 10.1186/ s12877-018-0813-4.

18. Urbanová B, Tomek A, Mikulík R et al. Vztah vaskulárních rizikových faktorů a Alzheimerovy choroby. Cesk Slov Neurol N 2012; 75/ 108(6): 694–699.

19. Lee HY, Li CC, Juan YS et al. Urinary incontinence in Alzheimer’s disease. Am J Alzheimers Dis Other Demen 2017; 32(1): 51–55. doi: 10.1177/ 1533317516680900.

20. Tsatali M, Papaliagkas V, Damigos D et al. Depression and anxiety levels increase chronic musculoskeletal pain in patients with Alzheimer’s disease. Curr Alzheimer Res 2014; 11(6): 574–579. doi: 10.2174/ 1567205011666140618103406.

21. Ressner P, Hort J, Rektorová I et al. Doporučené postupy pro di agnostiku Alzheimerovy nemoci a dalších onemocnění spojených s demencí. Cesk Slov Neurol N 2008; 71/ 104(4): 494–501.

22. Bäckman L, Jones S, Small BJ et al. Rate of cognitive decline in preclinical Alzheimer’s disease: the role of comorbidity. J Gerontol B Psychol Sci Soc Sci 2003; 58(4): P228–P236. doi: 10.1093/ geronb/ 58.4.p228.

23. Sinforiani E, Bernini S, Picascia M. Correlations among age, cognitive impairment, and comorbidities in Alzheimer’s disease: report from a center for cognitive disorders. Aging Clin Exp Res 2017; 29(6): 1299–1300. doi: 10.1007/ s40520-017-0807-7.

24. McCormick WC, Kukull WA, van Belle G et al. Symptom patterns and comorbidity in the early stages of Alzheimer’s disease. J Am Geriatr Soc 1994; 42(5): 517–521. doi: 10.1111/ j.1532-5415.1994.tb04974.x.