Effects of comorbidities and polypharmacy on disease progression in
Alzheimer's disease, minor cognitive impairment and dementia 
   Lead Investigator:    Tingting Zhang
   Institution      :    Brown University
   E-Mail           :    tingting_zhang@brown.edu
   Proposal ID      :    864



   Proposal Description:
   We aim to examine clusters of comorbidities and polypharmacy associated with      the progression of Alzheimer???s disease (AD), minor cognitive impairment (MCI)   and dementia. This will be a retrospective cohort study. Exposure to health       conditions will include vascular, physical, and mental health comorbidities.      Exposure to medications will be grouped into drug classes based on the            Anatomical Therapeutic Chemical Classification System. Progression of AD, MCI     and dementia will be defined as changes in memory, language, behavior, mental     health and functional activities during the follow-up. The association between    comorbidities, polypharmacy and disease progression will be measured using the    Generalized Estimating Equation. This approach allows the repeated measure of     the progression outcomes to be modeled over time, with progression event          expressed as continuous scores or ???present??? or ???absent??? of a specific     symptom. Separate models will be built for each neurological condition.           This study will be based on the NACC longitudinal Uniform Data Set (UDS). The     key variables will include: milestones, subject demographics, co-participant      demographics (INEDUC, INLIVWITH, INVISITS, INCALLS), subject medications,         subject health history, physical,  global staging-clinical dementia rating,       neuropsychological Battery Scores, geriatric depression scale, functional         activities questionnaire, clinician judgment of symptoms, and clinical            diagnosis for AD, MCI and dementia.