Dr. Virginie Dauphinot, Clinical and Research Memory Center, Hôpital des Charpennes, 27 rue Gabriel Péri, 69100 Villeurbanne, France. Tel: +33 (0) 472432203. Fax: +33 (0) 472432054, E-mail address:
J Prev Alzheimers Dis. 2024;11(4):1047-1054. doi: 10.14283/jpad.2024.51.
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.
本系统评价旨在探讨，使用合并症指数评估的更高合并症负担是否与认知障碍个体的功能自主性下降相关。检索了以下数据库：PubMed/MEDLINE、ScienceDirect、Cochrane 和 Embase。纳入了同时评估认知障碍个体的合并症指数与日常生活活动（ADL）量表之间关系的横断面和纵向研究。采用了美国国立卫生研究院（NIH）的观察性队列和横断面研究质量评估工具。共纳入了 12 项研究，其中 3 项为纵向研究。横断面设计（n=7 项研究）频繁报告了显著相关性，而仅有 1 项研究报告了显著的纵向相关性。这项纵向研究反复评估了合并症负担和功能自主性，并将合并症负担视为时变协变量。将合并症负担视为时变协变量可以处理其随时间的动态变化，并且在随访期间使用合并症指数和 ADL 量表进行重复评估，可以提高它们对随时间可靠测量合并症负担和功能自主性下降的敏感性。总之，更高的合并症指数与认知障碍患者的功能自主性水平较低相关。这种关系似乎随时间而变化，仅使用一次合并症指数和 ADL 量表可能无法处理合并症负担和功能自主性下降的波动。为了应对这种关系的复杂性，本综述强调了一些需要考虑的方法学方法。
