Background
Methods
Identifying the research question
Inclusion criteria
Searching for relevant studies
Search component | Search terms |
---|---|
#1 Dementia and diabetes
| ((Dementia OR Alzheimer OR cognitive impairment OR delirium) AND (Diabetes OR blood glucose self-monitoring) (Self management OR Self Care OR Self monitoring OR Service delivery OR Service organization OR Activities of daily living OR Caregivers OR Quality Assessment OR Quality OR Quality Indicators OR Quality of life OR Disease Progression OR Behaviour OR Impact OR Geriatric Assessment OR Severity of Illness OR Nursing Assessment OR Interprofessional OR Standard of Care OR Risk Factors OR Treatment outcome OR patient Experience) AND (Humans[Mesh])) |
#2 Dementia and stroke
| (Dementia[ti] OR Alzheimer[ti]) AND (stroke OR cerebrovascular OR CVA OR cerebrovascular disorders) AND (Self management OR Self Care OR Self monitoring OR Service delivery OR Service organization OR Activities of daily living OR Caregivers OR Quality Assessment OR Quality OR Quality Indicators OR Quality of life OR Disease Progression OR Behaviour OR Impact OR Geriatric Assessment OR Severity of Illness OR Nursing Assessment OR Interprofessional OR Standard of Care OR Risk Factors OR Treatment outcome OR patient Experience) AND (Humans[Mesh])) |
#3 Dementia and visual impairment
| (Dementia OR Alzheimer OR cognitive impairment OR delirium) AND (Eye diseases OR vision disorders OR Blindness OR visually impaired OR Nystagmus OR retinopathy OR macular degeneration OR glaucoma or cataract) AND (Self management OR Self Care OR Self monitoring OR Service delivery OR Service organization OR Activities of daily living OR Caregivers OR Quality Assessment OR Quality OR Quality Indicators OR Quality of life OR Disease Progression OR Behaviour OR Impact OR Geriatric Assessment OR Severity of Illness OR Nursing Assessment OR Interprofessional OR Standard of Care OR Risk Factors OR Treatment outcome OR patient Experience) |
#4 Dementia and comorbidity
| ((Dement*[ti] OR Alzheimer*[ti]) AND ((comorbidity OR co-morbidity OR comorbid OR “other medical conditions” OR “other chronic disease*” OR multimorbidity[ti] OR multi-morbidity[ti] OR multiple disease*[ti] OR multiple morbid*[ti] OR polypathology[ti] OR associated disease*[ti] OR associated disorder*[ti]) OR co-existence[ti] OR co-existing[ti] OR concomitant[ti] OR co-occurring[ti])) |
#5
| #1 OR #2 OR #3 OR #4 OR #5 |
Selecting studies and charting the data
Reporting the results
Results
Description of studies
Overview of study characteristics
Prevalence
Study and country | Study type | Dementia/CI | Control/comparison | Eligibility criteria | Recruited from | Number whole sample | Number dementia/CI | Diabetes (%) | Stroke (%) | VI (%) | Notes |
---|---|---|---|---|---|---|---|---|---|---|---|
Barnett [26] UK (Scotland) | Cross-sectional | Dementia | NA | Alive, permanently registered with a participating practice | Primary care -national dataset | 1751841 | 11139 | 13.3 | 18.8 | 3.8 | VI is blindness/low vision |
Doraiswamy [2] | Cross-sectional | Dementia | NA | Diagnosis of Alzheimer’s disease, 50 or over | Community health care sites | 679 | 679 | - | - | - | 61% had three or more comorbidities, 30% had vascular or heart disease. Sample included mixture of community dwelling and long-term care |
Feil [36] USA | Longitudinal cross sectional | CI | No CI | Geographically defined, 65 and over | Population derived sample | 7482 | 1774 | 26 | 34 | - | |
Heun [46] UK | Retrospective case control | Dementia | No dementia | Diagnosis of AD, 70+, in-patient care for at least 24 hours | Hospital in-patients | 72878 | 634 | 6 | 3 | 1 | VI is glaucoma. Diagnosis of diabetes less common in those with AD than controls RR 0.7 (95% CI 0.5 to 0.9). No significant difference in prevalence of ischemic stroke RR 1.3 95% CI 0.9 to 2.0, or glaucoma RR 2.0 (1.0 to 4.3) |
Jara [82] UK | Retrospective cohort | Dementia | No dementia | 64 and over, at least 24 months continuous enrolment, no cataract diagnosis at baseline | Primary care -national dataset | 650325 | 8124 | - | - | - | Lower rate of any cataract in AD group compared to controls HR 0.52 (95% CI 0.47 to 0.58) |
Löppönen [55] Finland | Cross-sectional | Dementia | NA | Geographically defined, 65 and over | Population based | 1260 | 112 | 16 | 24 | 29 | PWD less likely to be diagnosed with glaucoma OR 0.36; 95% CI 0.15 to 0.86), no difference in rates of cataract p =0.287 |
Lyketsos [56] USA | Case-control | Dementia/CI | No dementia/CI | Geographically defined, 65 and over | Population based | 695 | 374 | 20 | 16 | - | Stroke more common in people with dementia p <0.001 |
McCormick [58] USA | Case-control | Dementia/CI | No dementia/CI | Aged 60 and over, members of HMO, geographically defined | Population derived (from HMO database) | 154 | 154 | 6 | 3a
| 10 | Visual problems less common in PWD (10% versus 24%) |
Rait [64] UK | Cohort | Dementia | No dementia | 60 and over with first code for dementia during study period, at least six months data | Primary care - national dataset | 135174 | 22529 | 14 | 29a
| - | No difference in prevalence of diabetes (13.9% versus 14.5%) but cerebrovascular disease more common in people with dementia (29.3% versus 13.3%) |
Sakurai [65] Japan | Cross sectional | Dementia | NA | Dementia or MCI | Memory clinic | 160 | 160 | 19 | - | - | Dementia and CI |
Schubert [5] USA | Cross-sectional | Dementia | No dementia | 65 and older, seen primary care physician within two years. Excluded nursing home residents, non-English speaking | Primary care | 3013 | 107 | 39 | 10 | - | No significant difference in prevalence of DM (P =0.19) or stroke (P =0.89) between those with and without dementia |
Stephan [72] UK | Cross-sectional | MCI | No MCI | 65 and over | Population based | 13004 | 1486 | 7 | 19 | - | |
Uhlmann[75] USA | Case control | Dementia | No dementia | 65 and over, English speaking, eighth-grade or higher education, ability to complete audiometric evaluation | Adult medicine clinic | 174 | 87 | not given | not given | - | Prevalence of VI significantly higher in cases than controls (OR 2 95% CI 1.2-3.4). |
Zamrini [80] USA | Case control | Dementia | NA | Probable AD, black or white (white participants matched non randomly to black participants) | Memory clinic database | 334 | 334 | 18 | 9 | 10 | Includes all eye diseases |
Zekry [81] Switzerland | Cohort | Dementia | No dementia | 75 and over. Excluded: terminal illness, disorders interfering with psychometric assessment | Hospital in-patients | 349 | 188 | 19 | 22 | - | MCI + dementia |
Study and country | Type of study | Type of population | Control/comparison | Eligibility criteria | Recruited from | Number whole sample | Number dementia/CI |
---|---|---|---|---|---|---|---|
Bruce [30] Australia | Longitudinal cross sectional | DM | NA | Defined by post-code, 70 years or older, diabetes | Patients living in catchment area of hospital (63% of eligible patients recruited) | 223 | 34 (15.3%) |
Feil [38] USA | Longitudinal cross-sectional | DM | NA | Diagnosis of type 2 diabetes, 60 years or older | Geriatric clinic | 51 | 23 (45% CI) |
Feil [39] USA | Cross-sectional | DM | NA | Veterans aged 65 and older with diabetes mellitus | Research administration database (Veterans Health Administration) | 497000 | 65107 (13% dementia/CI) |
Hewitt [47] UK | Questionnaire | DM | NA | Type 2 diabetes, aged 75 and older, not resident in nursing homes | Data from RCT in Primary Care | 1047 | 235 (22.5% dementia/CI) |
Zhang [83] Australia | Retrospective cohort study | DM | NA | Veterans, 65 and older, received prescription for diabetes in previous six months | Health claims database | 17095 | 4.4% |
Saposnik [66] Canada | Retrospective cohort study | Stroke and dementia | Stroke no dementia | 18 years and older, first ischemic stroke | Stroke register (included patients admitted to 12 regional stroke centres in Ontario) | 10658 | 966 (9.1%) |
Whitson [78] USA | Cross-sectional | VI (macular disease) | NA | 65 and older, macular disease diagnoses | Low Vision Rehabilitation clinic | 101 | 19 (19%) |
Yochim [79] | Case series | VI (glaucoma) | NA | 50 and older, diagnosis of glaucoma | Glaucoma clinic | 41 | 44% (MCI) |
Prevalence of target comorbidities in people with dementia
Diabetes
Stroke
Visual impairment
Prevalence of dementia in people with stroke, diabetes and visual impairment
Quality of care
Study ID | Country | Comorbidity | Study type | Number of participants | Aspect of quality of care | Evidence that care is different? | Reported differences in care/treatment |
---|---|---|---|---|---|---|---|
Connolly [92] | UK | DM, Stroke | Cross sectional | 700 PWD (compared to people without dementia on QOF register) | Monitoring and treatment | Yes | PWD -significantly lower on 73% of QOF indicators; including peripheral pulses check, neuropathy testing, cholesterol measures for stroke. |
Curtis [33] | USA | VI (AMD) | Retrospective cohort | 284380 | Treatment | Yes | PWD significantly less likely to receive anti-VEGF RR 0.88 (95% CI 0.88 to 0.89) |
Guijarro [45] | Spain | VI, general | Cohort | 40482 | Treatment | Yes | PWD had some procedures less frequently than those without dementia. For example,cataract surgery (P <0.001), hernia repair, orthopaedic surgery |
Keenan [11] | UK | VI (AMD) | Cohort | 65894 (AMD cohort, 168092 dementia cohort) | Treatment | Yes | PWD significant decrease in likelihood of hospital admission for AMD P <0.001 |
Löppönen [55] | Finland | VI, general | Cross sectional (survey) | 1260 older people (112 PWD) | Diagnosis and treatment | Yes | PWD -more undiagnosed diseases compared to those without dementia (P =0.041) , less likely to be diagnosed with glaucoma (P =0.022) |
Müther [60] | Germany | DM, hypertension | Retrospective matched control | 216 PWD, 216 matched controls | Treatment | No | No significant differences in treatment for those with and without dementia. PWD more likely not to receive medication for hypertension or be treated with low-priced medications (not significant) |
Saposnik [66] | Canada | Stroke | Cohort | 877 with pre-existing dementia | Treatment | Yes | Patients with pre-existing dementia less likely to receive intravenous thrombolysis. |
877 controls (no pre-existing dementia) | |||||||
Sloan [69] | USA | Acute MI | Cross sectional | 5851 admitted for AMI with dementia, 123241 admitted for AMI without dementia | Treatment | Yes | PWD less likely to have a range of invasive procedures compared to those without a history of dementia |
Thorpe [74] | USA | DM, VI | Cohort | 288805 (44717 PWD) | Monitoring | Yes | PWD less likely to receive HbA1c tests (73% versus 81%), LDL-C tests (61% versus 79%), and eye examinations (52% versus 63%). |
Vitry [77] | Australia | DM | Cohort | 20134 veterans with diabetes (includes people with dementia/CI but numbers not clear) | Treatment | Yes | Presence of dementia associated with decreased likelihood of treatment intensification (for example, addition of antidiabetic medicine or switch to insulin/different medication) |
Zhang [83] | Australia | DM, VI | Cohort | 17095 veterans with and without diabetes (4.4% on dementia medication) | Treatment, access to services | Yes | Patients receiving medications prescribed for dementia less likely to use diabetic and optometry/ophthalmology services. |