Thinking About It All Together: A Descriptive Analysis to Understand Comorbidities in People Living With Dementia

The prevalence of Alzheimer's disease and related dementia (ADRD) is on the rise. There is a corresponding escalation in the number of persons living with dementia who require complex, longitudinal support in care due to the progressive declines in cognitive and clinical profiles of persons living with dementia when delivering individualized person-centered care that promotes overall health and well-being. Hence, we aim to describe the presence and patterns of co-occurring comorbidities in persons living with dementia.

This study is a retrospective, cross-sectional descriptive analysis based on curated electronic health record data from the All of Us Research Program from October 1, 2015, to June 30, 2022. We included individuals who were 65 years of age or older with at least one dementia-related diagnosis. We categorized 14 comorbidities by the Charlson Comorbidity Index, and defined all diseases based on the International Classification of Diseases Tenth Revision Diagnosis codes. We employed descriptive statistics and visualized data with UpSet Plots. Demographic characteristics (i.e., age, sex, race, and ethnicity) between people with and without co-occurring comorbidities were compared with either chi-square or Wilcoxon signed-rank tests.

Persons living with dementia (N = 4003) were a mean of 73 years old, 72.5% non-Hispanic White, and 47.5% female. Approximately 87% of persons living with dementia were diagnosed with at least one additional comorbidity. The most common comorbidities included diabetes (67.82%), renal disease (40.24%), chronic pulmonary disease (39.85%), congestive heart failure (37.37%), and peripheral vascular disease (34.57%). Heterogeneous patterns of co-occurring comorbidity were noted among persons living with dementia.

Our study demonstrates the high prevalence of co-occurring comorbid illness among persons living with dementia. It is critical that the impact of these co-occurring conditions on patients' disease trajectories be better understood to promote treatment choices that are person-centered and goal-concordant.