Introduction: The lack of longitudinal data of comorbidity burden makes the association between comorbidity and cognitive decline inconclusive. We aimed to measure comorbidity and assess its effects on cognitive decline in mild to moderate dementia. Methods: This was a prospective cohort study. The participants were enrolled from the Hualien Tzu Chi Hospital between January 2015 and December 2018. We enrolled 175 older adults with mild to moderate dementia and conducted in-person interviews to follow-up comorbidity and cognitive function annually. The comorbidity burden indices included Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Charlson Comorbidity Index (CCI), and Medication Regimen Complexity Index (MRCI), and cognitive function was measured by Mini-Mental State Examination (MMSE) and clock drawing test. We employed the generalized estimating equations to assess the longitudinal effect of time-varying comorbidity burden on cognitive decline after adjusting for age, sex, and education. Results: Most patients were diagnosed with Alzheimer’s disease (88.6%) and in the early stage of dementia (Clinical Dementia Rating [CDR] = 0.5, 57.1%; CDR = 1, 36.6%). Multimorbidity was common (median: 3), and the top 3 most common comorbidities were osteoarthritis (67.4%), hypertension (65.7%), and hyperlipidemia (36.6%). The severity index of CIRS-G was significantly associated with cognitive decline in MMSE after adjusting for age, sex, and education. CCI and MRCI scores were, however, not associated with cognitive function. Conclusion: The severity index of CIRS-G outperforms CCI and MRCI in reflecting the longitudinal effect of comorbidity burden on cognitive decline in mild to moderate dementia.
Dement Geriatr Cogn Disord

中文翻译：

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合并症负担对认知衰退的影响：老年痴呆症的前瞻性队列研究

介绍：缺乏共病负担的纵向数据使得共病与认知能力下降之间的关联尚无定论。我们旨在测量合并症并评估其对轻度至中度痴呆症认知能力下降的影响。方法：这是一项前瞻性队列研究。参与者是在 2015 年 1 月至 2018 年 12 月期间从花莲慈济医院招募的。我们招募了 175 名患有轻度至中度痴呆症的老年人，并每年进行面对面的随访，以随访合并症和认知功能。合并症负担指数包括老年病累积疾病评定量表（CIRS-G）、查尔森合并症指数（CCI）和用药方案复杂性指数（MRCI），认知功能通过简易精神状态检查（MMSE）和时钟绘图测量测试。在调整年龄、性别和教育后，我们采用广义估计方程来评估随时间变化的合并症负担对认知能力下降的纵向影响。结果：大多数患者被诊断出患有阿尔茨海默病 (88.6%) 并且处于痴呆的早期阶段（临床痴呆评分 [CDR] = 0.5, 57.1%；CDR = 1, 36.6%）。多发病很常见（中位数：3），前 3 位最常见的合并症是骨关节炎（67.4%）、高血压（65.7%）和高脂血症（36.6%）。在调整年龄、性别和教育后，CIRS-G 的严重程度指数与 MMSE 的认知下降显着相关。然而，CCI 和 MRCI 评分与认知功能无关。结论：在反映合并症负担对轻中度痴呆认知下降的纵向影响方面，CIRS-G 的严重程度指数优于 CCI 和 MRCI。
老年痴呆症认知障碍