AMB undertook data extraction, quality assessment and analysis and helped to write the paper. CG participated in study design, interpretation of the results and helped to revise the paper. GR participated in study design, interpretation of the results and helped to revise the paper. CB participated in study design, interpretation of the results and critical review of the paper.
LR participated in study design, interpretation of the results and critical review of the paper. SN participated in the design of the study and advised on interpretation of the prevalence data. JS participated in study design, interpretation of the results and critical review of the paper.
FB confirms that the manuscript is an honest, accurate, and transparent account of the study being reported, that no important aspects of the study have been omitted, and that any discrepancies from the review as planned have been explained. All authors read and approved the final manuscript.
Frances Bunn, Email: ku. Anne-Marie Burn, Email: ku. Claire Goodman, Email: ku. Greta Rait, Email: ku. Sam Norton, Email: ku. Louise Robinson, Email: ku. Johan Schoeman, Email: ten. Carol Brayne, Email: ku. National Center for Biotechnology Information , U. BMC Med. Published online Oct Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Jul 23; Accepted Sep This article has been cited by other articles in PMC. Abstract Background Evidence suggests that amongst people with dementia there is a high prevalence of comorbid medical conditions and related complaints.
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Methods We undertook a scoping review including all types of research relating to the prevalence of comorbidities in people with dementia; current systems, structures and other issues relating to service organisation and delivery; patient and carer experiences; and the experiences and attitudes of service providers.
Results We included 54 primary studies, eight reviews and three guidelines. Conclusions The prevalence of comorbid conditions in people with dementia is high. Electronic supplementary material The online version of this article doi Background World-wide there are an estimated Identifying the research question Inclusion criteria We included studies involving people with dementia who had an additional comorbid health condition. Searching for relevant studies We searched for a representative range of material which provided an overview of current knowledge and that identified some key examples of developments in the organisation and delivery of care for people with dementia and comorbid conditions.
Comorbidity | Progress In Mind
Table 1 Search strategy used in PubMed. Open in a separate window. Selecting studies and charting the data Electronic search results were downloaded into EndNote bibliographic software and, where possible, duplicates deleted. Reporting the results Studies were grouped into the following categories: 1 prevalence, 2 quality of care, 3 views and experiences patients, carers and health care professionals and 4 health service organisation and delivery.
Results Description of studies We included 74 papers, 65 of which were classified as primary references [ 2 , 5 , 11 , 13 , 23 - 83 ] and nine as associated papers [ 84 - 92 ]. Figure 1. Prevalence Our main aim was to look at the prevalence of comorbidity in particular stroke, diabetes and visual impairment in people with dementia. Table 2 Prevalence of diabetes, visual impairment and stroke in people with dementia. Diagnosis of diabetes less common in those with AD than controls RR 0. No significant difference in prevalence of ischemic stroke RR 1. Table 3 Prevalence of dementia in people with stroke, diabetes and visual impairment.
Prevalence of target comorbidities in people with dementia Diabetes Twelve studies reported the prevalence of diabetes in populations of people with dementia [ 5 , 26 , 46 , 55 , 56 , 58 , 64 , 65 , 80 , 81 ] or MCI [ 36 , 72 ].
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Stroke Nine studies reported the prevalence of stroke in people with dementia [ 5 , 26 , 46 , 55 , 56 , 58 , 64 , 80 , 81 ] and two in people with cognitive impairment [ 36 , 72 ]. Visual impairment Four studies reported the prevalence of some form of visual impairment in people with dementia, including all eye diseases [ 80 ], glaucoma [ 46 , 55 ] and cataracts [ 55 , 82 ]. Prevalence of dementia in people with stroke, diabetes and visual impairment Five studies looked at the prevalence of dementia or cognitive impairment in populations of people with diabetes.
Quality of care We categorised 23 studies as relating to quality of care in some way, 11 of which compared access to treatment or receipt of services in groups with and without dementia. Table 4 Impact of dementia and medical comorbidities on quality of care and access to treatment.
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PWD more likely not to receive medication for hypertension or be treated with low-priced medications not significant Saposnik [ 66 ] Canada Stroke Cohort with pre-existing dementia Treatment Yes Patients with pre-existing dementia less likely to receive intravenous thrombolysis.
Views and experiences We included 11 studies looking at views and experiences of people with dementia, their family carers and health care professionals. Models of care for older people with cognitive impairment A number of initiatives have been developed to improve the care of older people with dementia in acute hospitals, including liaison psychiatric services [ 50 , 73 ] or specialist units that combine medical and mental health care for older people [ 41 , 44 ].
Discussion We included 54 primary studies, eight reviews and two guidelines that addressed issues around dementia and comorbidity. Recommendations for research The review highlights significant gaps in the evidence. Endnotes a All numbers refer to the numbers of studies not individual participants. Acknowledgements We would like to thank Reinhard Wentz who helped design and run the database searches and Professor Bruce Guthrie for providing us with additional unpublished data.
Additional files Additional file 1: 42K, docx Table of included studies. Additional file 2: 22K, docx Prevalence studies — information on study populations, recruitment and participation. Additional file 3: 22K, docx Prevalence studies — information on methods of data collection. Footnotes Competing interests The authors declare that they have no competing interests.
Contributor Information Frances Bunn, Email: ku. References 1. Prince M, Jackson J. World alzheimer report Implications of comorbidity on costs for patients with Alzheimer disease. Med Care. Health Aff Millwood ; 17 Comorbidity profile of dementia patients in primary care: are they sicker?
J Am Geriatr Soc. Richards M, Brayne C.
Comorbidity and dementia: a scoping review of the literature
Skoog I. J Neural Transm Suppl. Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. Associations between age-related macular degeneration, Alzheimer disease, and dementia: record linkage study of hospital admissions. JAMA Ophthalmol. Dementia in the acute hospital: prospective cohort study of prevalence and mortality.