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Association between Comorbidity Indices and Functional Autonomy in Individuals with Cognitive Impairment: A Systematic Review

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Abstract

This systematic review aimed to examine whether higher comorbidity burden, as assessed by comorbidity indices, was associated with a functional autonomy decline in individuals with cognitive impairment. The search was conducted in the following databases: PubMed/MEDLINE, ScienceDirect, Cochrane, and Embase. Both cross-sectional and longitudinal studies that examined the relationship between comorbidity indices and scales measuring activities of daily living (ADL) in individuals with cognitive impairment were included. The quality assessment tool for observational cohort and cross-sectional studies of the National Institutes of Health (NIH) was used. Overall, 12 studies were included, among which three were longitudinal. Significant association was frequently reported by cross-sectional designs (n=7 studies) and only one study reported a significant longitudinal association. This longitudinal study repeatedly assessed both comorbidity burden and functional autonomy, and considered comorbidity burden as a time-varying covariate. Considering comorbidity burden as a time varying covariate may deal with the dynamic nature of comorbidity burden over time, and conducting repeated assessments during the follow-up using both comorbidity index and ADL scales may increase their sensitivity to reliably measure comorbidity burden and functional autonomy decline over time. In conclusion, a higher comorbidity index was associated with a lower level of functional autonomy in people with cognitive impairment. This relationship seems to be dynamic over time and using comorbidity indices and ADL scales only once may not deal with the fluctuation of both comorbidity burden and functional autonomy decline. To cope with complexity of this relationship this review highlights some methodological approaches to be considered.

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References

  1. The Lancet Public Health. Reinvigorating the public health response to dementia. Lancet Public Health. 2021;6(10):e696. doi:https://doi.org/10.1016/S2468-2667(21)00215-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Chen TB, Yiao SY, Sun Y, et al. Comorbidity and dementia: A nationwide survey in Taiwan. PLOS ONE. 2017;12(4):e0175475. doi:https://doi.org/10.1371/journal.pone.0175475

    Article  PubMed  PubMed Central  Google Scholar 

  3. Poblador-Plou B, Calderón-Larrañaga A, Marta-Moreno J, et al. Comorbidity of dementia: a cross-sectional study of primary care older patients. BMC Psychiatry. 2014;14:84. doi:https://doi.org/10.1186/1471-244X-14-84

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kao SL, Wang JH, Chen SC, Li YY, Yang YL, Lo RY. Impact of Comorbidity Burden on Cognitive Decline: A Prospective Cohort Study of Older Adults with Dementia. Dement Geriatr Cogn Disord. 2021;50(1):43–50. doi:https://doi.org/10.1159/000514651

    Article  PubMed  Google Scholar 

  5. Vance D, Larsen KI, Eagerton G, Wright MA. Comorbidities and cognitive functioning: implications for nursing research and practice. J Neurosci Nurs. 2011;43(4):215–224. doi:https://doi.org/10.1097/JNN.0b013e3182212a04

    Article  PubMed  Google Scholar 

  6. Stuck AE, Walthert JM, Nikolaus T, Büla CJ, Hohmann C, Beck JC. Risk factors for functional status decline in community-living elderly people: a systematic literature review. Social Science & Medicine. 1999;48(4):445–469. doi:https://doi.org/10.1016/S0277-9536(98)00370-0

    Article  CAS  Google Scholar 

  7. Falvey JR, Gustavson AM, Price L, Papazian L, Stevens-Lapsley JE. Dementia, Comorbidity, and Physical Function in the Program of All-Inclusive Care for the Elderly. J Geriatr Phys Ther. 2019;42(2):E1–E6. doi:https://doi.org/10.1519/JPT.0000000000000131

    Article  PubMed  PubMed Central  Google Scholar 

  8. Aubert CE, Kabeto M, Kumar N, Wei MY. Multimorbidity and long-term disability and physical functioning decline in middle-aged and older Americans: an observational study. BMC Geriatrics. 2022;22(1):910. doi:https://doi.org/10.1186/s12877-022-03548-9

    Article  PubMed  PubMed Central  Google Scholar 

  9. Buckinx F, Peyrusqué E, Kergoat MJ, Aubertin-Leheudre M. Reference Standard for the Measurement of Loss of Autonomy and Functional Capacities in Long-Term Care Facilities. J Frailty Aging. 2023;12(3):236–243. doi:https://doi.org/10.14283/jfa.2023.4

    CAS  PubMed  Google Scholar 

  10. Slaughter SE, Hayduk LA. Contributions of environment, comorbidity, and stage of dementia to the onset of walking and eating disability in long-term care residents. J Am Geriatr Soc. 2012;60(9):1624–1631. doi:https://doi.org/10.1111/j.1532-5415.2012.04116.x

    Article  PubMed  Google Scholar 

  11. Nelis SM, Wu YT, Matthews FE, et al. The impact of co-morbidity on the quality of life of people with dementia: findings from the IDEAL study. Age Ageing. 2019;48(3):361–367. doi:https://doi.org/10.1093/ageing/afy155

    Article  PubMed  Google Scholar 

  12. Tanaka H, Nagata Y, Ishimaru D, Ogawa Y, Fukuhara K, Nishikawa T. Clinical factors associated with activities of daily living and their decline in patients with severe dementia. Psychogeriatrics. 2020;20(3):327–336. doi:https://doi.org/10.1111/psyg.12502

    Article  PubMed  Google Scholar 

  13. Rozzini R, Frisoni GB, Ferrucci L, et al. Geriatric Index of Comorbidity: validation and comparison with other measures of comorbidity. Age Ageing. 2002;31(4):277–285. doi:https://doi.org/10.1093/ageing/31.4.277

    Article  PubMed  Google Scholar 

  14. Aslam F, Khan NA. Tools for the Assessment of Comorbidity Burden in Rheumatoid Arthritis. Front Med (Lausanne). 2018;5:39. doi:https://doi.org/10.3389/fmed.2018.00039

    Article  PubMed  Google Scholar 

  15. Marshall GA, Amariglio RE, Sperling RA, Rentz DM. Activities of daily living: where do they fit in the diagnosis of Alzheimer’s disease? Neurodegener Dis Manag. 2012;2(5):483–491. doi:https://doi.org/10.2217/nmt.12.55

    Article  PubMed  Google Scholar 

  16. Haaksma ML, Vilela LR, Marengoni A, et al. Comorbidity and progression of late onset Alzheimer’s disease: A systematic review. PLOS ONE. 2017;12(5):e0177044. doi:https://doi.org/10.1371/journal.pone.0177044

    Article  PubMed  PubMed Central  Google Scholar 

  17. Tekin S, Fairbanks LA, O’Connor S, Rosenberg S, Cummings JL. Activities of daily living in Alzheimer’s disease: neuropsychiatric, cognitive, and medical illness influences. Am J Geriatr Psychiatry. 2001;9(1):81–86.

    Article  CAS  PubMed  Google Scholar 

  18. Doraiswamy PM, Leon J, Cummings JL, Marin D, Neumann PJ. Prevalence and impact of medical comorbidity in Alzheimer’s disease. J Gerontol A Biol Sci Med Sci. 2002;57(3):M173–177. doi:https://doi.org/10.1093/gerona/57.3.m173

    Article  PubMed  Google Scholar 

  19. Oosterveld SM, Kessels RPC, Hamel R, et al. The influence of co-morbidity and frailty on the clinical manifestation of patients with Alzheimer’s disease. J Alzheimers Dis. 2014;42(2):501–509. doi:https://doi.org/10.3233/JAD-140138

    Article  PubMed  Google Scholar 

  20. Leoutsakos JMS, Han D, Mielke MM, et al. Effects of general medical health on Alzheimer’s progression: the Cache County Dementia Progression Study. Int Psychogeriatr. 2012;24(10):1561–1570. doi:https://doi.org/10.1017/S104161021200049X

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lyketsos CG, Galik E, Steele C, et al. The General Medical Health Rating: a bedside global rating of medical comorbidity in patients with dementia. J Am Geriatr Soc. 1999;47(4):487–491. doi:https://doi.org/10.1111/j.1532-5415.1999.tb07245.x

    Article  CAS  PubMed  Google Scholar 

  22. Solomon A, Dobranici L, Kåreholt I, Tudose C, Lăzărescu M. Comorbidity and the rate of cognitive decline in patients with Alzheimer dementia. Int J Geriatr Psychiatry. 2011;26(12):1244–1251. doi:https://doi.org/10.1002/gps.2670

    Article  PubMed  Google Scholar 

  23. Melis RJF, Marengoni A, Rizzuto D, et al. The influence of multimorbidity on clinical progression of dementia in a population-based cohort. PLoS One. 2013;8(12):e84014. doi:https://doi.org/10.1371/journal.pone.0084014

    Article  ADS  PubMed  PubMed Central  Google Scholar 

  24. PRISMA_update_protocol_20180214.pdf. Published online February 14, 2018. Accessed July 27, 2023. https://osf.io/https://osf.io/2v7mk

  25. Nicholson K, Makovski TT, Griffith LE, Raina P, Stranges S, van den Akker M. Multimorbidity and comorbidity revisited: refining the concepts for international health research. J Clin Epidemiol. 2019;105:142–146. doi:https://doi.org/10.1016/j.jclinepi.2018.09.008

    Article  PubMed  Google Scholar 

  26. Falagas ME, Pitsouni EI, Malietzis GA, Pappas G. Comparison of PubMed, Scopus, Web of Science, and Google Scholar: strengths and weaknesses. FASEB J. 2008;22(2):338–342. doi:https://doi.org/10.1096/fj.07-9492LSF

    Article  CAS  PubMed  Google Scholar 

  27. Ma LL, Wang YY, Yang ZH, Huang D, Weng H, Zeng XT. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Military Medical Research. 2020;7(1):7. doi:https://doi.org/10.1186/s40779-020-00238-8

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wubben N, Haaksma M, Ramakers IHGB, et al. A comparison of two approaches for modeling dementia progression in a changing patient context. Int J Geriatr Psychiatry. 2022;37(5). doi:https://doi.org/10.1002/gps.5706

  29. King LA, Priest KC, Nutt J, et al. Comorbidity and functional mobility in persons with Parkinson disease. Arch Phys Med Rehabil. 2014;95(11):2152–2157. doi:https://doi.org/10.1016/j.apmr.2014.07.396

    Article  PubMed  PubMed Central  Google Scholar 

  30. Mariani E, Monastero R, Ercolani S, et al. Influence of comorbidity and cognitive status on instrumental activities of daily living in amnestic mild cognitive impairment: results from the ReGAl project. Int J Geriatr Psychiatry. 2008;23(5):523–530. doi:https://doi.org/10.1002/gps.1932

    Article  CAS  PubMed  Google Scholar 

  31. van Rossum ME, Koek HL. Predictors of functional disability in mild cognitive impairment and dementia. Maturitas. 2016;90:31–36. doi:https://doi.org/10.1016/j.maturitas.2016.05.007

    Article  CAS  PubMed  Google Scholar 

  32. Boltz M, Resnick B, Kuzmik A, et al. Pain Incidence, Treatment, and Associated Symptoms in Hospitalized Persons with Dementia. Pain Manag Nurs. 2021;22(2):158–163. doi:https://doi.org/10.1016/j.pmn.2020.08.002

    Article  PubMed  Google Scholar 

  33. Samus QM, Mayer L, Onyike CU, et al. Correlates of functional dependence among recently admitted assisted living residents with and without dementia. J Am Med Dir Assoc. 2009;10(5):323–329. doi:https://doi.org/10.1016/j.jamda.2009.01.004

    Article  PubMed  PubMed Central  Google Scholar 

  34. Meghani SH, Buck HG, Dickson VV, et al. The Conceptualization and Measurement of Comorbidity: A Review of the Interprofessional Discourse. Nurs Res Pract. 2013;2013:192782. doi:https://doi.org/10.1155/2013/192782

    PubMed  PubMed Central  Google Scholar 

  35. Wadley VG, Crowe M, Marsiske M, et al. Changes in everyday function among individuals with psychometrically defined Mild Cognitive Impairment in the ACTIVE Study. J Am Geriatr Soc. 2007;55(8):1192–1198. doi:https://doi.org/10.1111/j.1532-5415.2007.01245.x

    Article  PubMed  PubMed Central  Google Scholar 

  36. Quiñones AR, Markwardt S, Thielke S, Rostant O, Vásquez E, Botoseneanu A. Prospective Disability in Different Combinations of Somatic and Mental Multimorbidity. J Gerontol A Biol Sci Med Sci. 2018;73(2):204–210. doi:https://doi.org/10.1093/gerona/glx100

    Article  PubMed  Google Scholar 

  37. Jiang X, Wang L, Morgenstern LB, Cigolle CT, Claflin ES, Lisabeth LD. New Index for Multiple Chronic Conditions Predicts Functional Outcome in Ischemic Stroke. Neurology. 2021;96(1):e42–e53. doi:https://doi.org/10.1212/WNL.0000000000010992

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Zhuang S, Wang HF, Li J, Wang HY, Wang X, Xing CM. Renin-angiotensin system blockade use and risks of cognitive decline and dementia: A meta-analysis. Neurosci Lett. 2016;624:53–61. doi:https://doi.org/10.1016/j.neulet.2016.05.003

    Article  CAS  PubMed  Google Scholar 

  39. Tully PJ, Hanon O, Cosh S, Tzourio C. Diuretic antihypertensive drugs and incident dementia risk: a systematic review, meta-analysis and meta-regression of prospective studies. J Hypertens. 2016;34(6):1027–1035. doi:https://doi.org/10.1097/HJH.0000000000000868

    Article  CAS  PubMed  Google Scholar 

  40. Fox C, Smith T, Maidment I, et al. Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality: a systematic review. Age Ageing. 2014;43(5):604–615. doi:https://doi.org/10.1093/ageing/afu096

    Article  PubMed  Google Scholar 

  41. Liu L, Jia L, Jian P, et al. The Effects of Benzodiazepine Use and Abuse on Cognition in the Elders: A Systematic Review and Meta-Analysis of Comparative Studies. Front Psychiatry. 2020;11:00755. doi:https://doi.org/10.3389/fpsyt.2020.00755

    Article  ADS  PubMed  PubMed Central  Google Scholar 

  42. Bunn F, Burn AM, Goodman C, et al. Comorbidity and dementia: a scoping review of the literature. BMC Medicine. 2014;12(1):192. doi:https://doi.org/10.1186/s12916-014-0192-4

    Article  PubMed  PubMed Central  Google Scholar 

  43. Castellanos-Perilla N, Borda MG, Fernández-Quilez Á, Aarsland V, Soennesyn H, Cano-Gutiérrez CA. Factors associated with functional loss among community-dwelling Mexican older adults. Biomedica. 2020;40(3):546–556. doi:https://doi.org/10.7705/biomedica.5380

    Article  PubMed  PubMed Central  Google Scholar 

  44. Gardener EA, Huppert FA, Guralnik JM, Melzer D. Middle-aged and mobility-limited: prevalence of disability and symptom attributions in a national survey. J Gen Intern Med. 2006;21(10):1091–1096. doi:https://doi.org/10.1111/j.1525-1497.2006.00564.x

    Article  PubMed  PubMed Central  Google Scholar 

  45. Valletta M, Vetrano DL, Calderón-Larrañaga A, et al. Association of mild and complex multimorbidity with structural brain changes in older adults: A population-based study. Alzheimers Dement. Published online January 3, 2024. doi:https://doi.org/10.1002/alz.13614

  46. Canaslan K, Ates Bulut E, Kocyigit SE, Aydin AE, Isik AT. Predictivity of the comorbidity indices for geriatric syndromes. BMC Geriatr. 2022;22(1):440. doi:https://doi.org/10.1186/s12877-022-03066-8

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Mohamed Nour Temedda (PhD student) is supported by “France Médéric d’Alzheimer” (Research scholarship). We thank the Dr Philip Robinson (Hospices Civils de Lyon) for help in manuscript preparation.

Funding

Funding: None.

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Authors and Affiliations

  1. Clinical and Research Memory Centre of Lyon (CMRR), Geriatrics Unit, Research Clinical Centre (CRC) - VCF (Aging Brain Frailty), Hospices civils de Lyon, F-69100, Villeurbanne, France

    M. N. Temedda, A. Garnier-Crussard, C. Mouchoux &  Virginie Dauphinot

  2. University Lyon 1, F-69000, Lyon, France

    M. N. Temedda, A. Garnier-Crussard, C. Mouchoux &  Virginie Dauphinot

  3. Pharmaceutical Unit, Charpennes Hospital, University Hospital of Lyon, F-69100, Villeurbanne, France

    M. N. Temedda & C. Mouchoux

  4. INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, University Lyon 1, F-69000, Lyon, France

    A. Garnier-Crussard

  5. PhIND «Physiopathology and Imaging of Neurological Disorders», NeuroPresage Team, Institut Blood and Brain @Caen-Normandie, Cyceron, Normandie Univ, UNICAEN, INSERM, U1237, F-14000, Caen, France

    C. Mouchoux

  6. Clinical and Research Memory Center, Hôpital des Charpennes, 27 rue Gabriel Péri, 69100, Villeurbanne, France

    Virginie Dauphinot

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  1. M. N. Temedda
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  2. A. Garnier-Crussard
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  4. Virginie Dauphinot
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Contributions

Authors’ contributions: Mohamed Nour Temedda: Conceptualization, Methodology, Data analysis, Writing - Original Draft. Antoine Garnier-Crussard: Writing - Review & Editing. Christelle Mouchoux: Conceptualization, Methodology, Analysis, Writing - Original Draft, Supervision. Virginie Dauphinot: Conceptualization, Methodology, Data analysis, Writing - Original Draft, Supervision.

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Correspondence to Virginie Dauphinot.

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Conflict of Interest: The authors declare no competing interests; this manuscript has not been published or submitted elsewhere. All authors have contributed significantly, and all authors are in agreement with the content of the manuscript.

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Temedda, M.N., Garnier-Crussard, A., Mouchoux, C. et al. Association between Comorbidity Indices and Functional Autonomy in Individuals with Cognitive Impairment: A Systematic Review. J Prev Alzheimers Dis (2024). https://doi.org/10.14283/jpad.2024.51

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  • DOI: https://doi.org/10.14283/jpad.2024.51

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