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Observational Study
. 2025 Apr 16;25(1):254.
doi: 10.1186/s12877-025-05898-6.

Association between comorbidity indices and nursing home admission in patients with Alzheimer's disease: a longitudinal observational study using the MEMORA cohort

Mohamed Nour Temedda  1   2   3 , Antoine Garnier-Crussard  1   3   4 , Claire Moutet  1   3 , Christelle Mouchoux  1   2   3   5 , Virginie Dauphinot  6   7   8
Affiliations
Observational Study

Association between comorbidity indices and nursing home admission in patients with Alzheimer's disease: a longitudinal observational study using the MEMORA cohort

Mohamed Nour Temedda et al. BMC Geriatr. .

Abstract

Background: Alzheimer's disease (AD) is among the leading cause of nursing home admission (NHA). Identifying potentially modifiable factors associated with the risk of NHA is crucial to reduce this risk in individuals with AD.

Objective: We aimed to assess the relationship between comorbidity burden, as measured by the Charlson comorbidity index, the multimorbidity-weighted index and the health related quality of life comorbidity index, and NHA in patients with AD.

Methods: We conducted an observational longitudinal study including patients from the MEMORA real-life cohort. Patients had to be aged 60 years or older, with a diagnosis of AD. The association between comorbidity indices and occurrence of NHA was assessed using Cox proportional-hazards models and competing-risks regressions considering mortality as a competing event. All analyses were adjusted for age, sex, educational level, stage of AD and the presence of neuropsychiatric symptoms.

Results: Overall, 488 AD patients were included (68.2% with dementia). There were 125 (26%) NHA that occurred during the follow-up, with a median time of 25 months until NHA. Higher level of comorbidity burden as measured by the three comorbidity indices was associated with higher risk of NHA compared to lower level of comorbidity burden. Similar findings were found after considering mortality as a competing event, with a HR of 2.41(95%CI:1.36-4.28, p = 0.003) for MWI, an HR of 1.96(95%CI:1.22-3.17, p = 0.006), and an HR of 1.68(95%CI:1.04-2.71, p = 0.034).

Conclusion: The implementation of appropriate interventions that aim to improve the management of the comorbidity burden could help to reduce the risk of NHA in individuals with AD.

Keywords: Comorbidity burden; Comorbidity index; Dementia, Alzheimer’s disease; Nursing home.

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Conflict of interest statement

Declarations. Ethical consideration: Information was individually provided to the patients and caregivers, and oral consent had to be obtained to participate, as required by the French committee for this type of study. The MEMORA cohort protocol (clinicaltrial.gov number NCT02302482) has been approved by the regional ethics committee (Comité de protection des personnes Sud Est III) on July 29, 2014, the Advisory Committee on Information Processing in Material Research in the Field of Health, and the National Commission for Data Protection and Liberties (CNIL). These approvals are in line with the principles of the Helsinki Declaration. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Conflict of interest (declared to the corresponding author): Independent of this work, A.G.C is an unpaid sub-investigator or local principal investigator in NCT04867616 (UCB Pharma), NCT04241068 (Biogen), NCT05310071 (Biogen), NCT03446001 (TauRx Therapeutics), NCT03444870 (Roche), NCT04374253 (Roche), NCT04777396 (Novo Nordisk), NCT04777409 (Novo Nordisk), NCT04770220 (Alzheon), NCT05423522 (Medesis Pharma), NCT06079190 (GlaxoSmithKline). M.N.T, C.Mt, C.Mc and VD declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. This manuscript has not been published or submitted elsewhere. All authors have contributed significantly, and all authors are in agreement with the content of the manuscript. Declarations of Generative AI and AI-assisted technologies in the writing process: During the preparation of this work the first author (M.N.T) used ChatGPT in order to correct English mistakes. After using this tool, the authors reviewed and edited the content as needed and takes full responsibility for the content of the published article.

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