Mild cognitive impairment in combination with comorbid diabetes mellitus and hypertension is negatively associated with health-related quality of life among older persons in Taiwan
To fill the gap in knowledge about associations of health-related quality of life (HRQoL) with comorbid diabetes mellitus (DM), hypertension (HTN), and/or mild cognitive impairment (MCI) in the elderly, we explored associations of comorbid DM, HTN, and/or MCI with HRQoL.
Data for this study were from a population-based cross-sectional survey of elderly Taiwanese (≥ 65 years old). Participants (N = 4,634; 47.9% male) were categorized into eight chronic-illness groups: DM only (n = 224); HTN only (n = 1226); DM and HTN (n = 365); MCI only (n = 497); DM and MCI (n = 58); HTN and MCI (n = 303); DM, HTN, and MCI (n = 101); and none (healthy; n = 1860). Associations were examined between the eight chronic-illness groups and HRQoL (measured by EQ-5D scores) using binary logistic regression analyses and generalized linear models adjusted for covariates. Index scores were calculated from EQ-5D scores using Taiwan’s general population-preference weights.
Compared to the healthy group, after adjusting covariates, MCI alone or with other comorbidities was significantly, negatively associated with HRQoL. Among all chronic-illness groups, comorbid DM, HTN, and MCI exhibited the lowest HRQoL. After adjusting covariates, between-group odds ratios for index scores were significant when comparing comorbid DM and MCI to DM only, comparing comorbid HTN and MCI to HTN only and comorbid DM, comparing HTN and MCI to comorbid DM and HTN, suggesting that MCI additively affects HRQoL.
HRQoL of older Taiwanese adults was negatively associated with having MCI. Thus, clinicians managing older persons with chronic illnesses should assess their cognitive function to identify high-risk groups needing HRQoL assistance.
KeywordsMild cognitive impairment Diabetes mellitus Hypertension Health-related quality of life
The authors would like to express their gratitude to the Taiwan Alzheimer’s Disease Association for generously allowing us to use an invaluable database that they partly developed and supporting us under the commission of the Ministry of Health and Welfare of Taiwan (DOH100-TD-M113-100001). The views expressed throughout this study are exclusively those of the authors and do not represent the views or opinions of the Ministry of Health and Welfare, Taiwan.
This work was supported by the Chang Gung Medical Foundation [grant numbers BMRP297, CMRPD1E0162] and Healthy Aging Research Center, Chang Gung University, Taiwan [grant number EMRPD1H0361, EMRPD1H0551].
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The data were approved by the National Taiwan University Hospital’s Institutional Review Board. Informed consent was obtained from the participants or their proxy.
- 1.Department of Statistics, Ministry of Interior, Taiwan. (2018). Monthly bulletin of interior statistics: 1.5 Population by age of 0–14, 15–64, 65+ and by 6-year age group [Data file]. Retrieved from https://www.moi.gov.tw/files/site_stuff/321/1/month/m1-05.xls.
- 2.National Development Council, Taiwan. (2016). Population projections for R.O.C. (Taiwan): 2016–2060. Retrieved from https://www.ndc.gov.tw/en/cp.aspx?n=2E5DCB04C64512CC.
- 5.Lonie, J. A., Parra-Rodriguez, M. A., Tierney, K. M., Herrmann, L. L., Donaghey, C., O’Carroll, R. E., et al. (2010). Predicting outcome in mild cognitive impairment: 4-year follow-up study. The British Journal of Psychiatry, 197(2), 135–140. https://doi.org/10.1192/bjp.bp.110.077958.CrossRefGoogle Scholar
- 6.Ryuno, H., Kamide, K., Gondo, Y., Kabayama, M., Oguro, R., Nakama, C., et al. (2017). Longitudinal association of hypertension and diabetes mellitus with cognitive functioning in a general 70-year-old population: The SONIC study. Hypertension Research, 40(7), 665–670. https://doi.org/10.1038/hr.2017.15.CrossRefGoogle Scholar
- 9.Li, J. Q., Tan, L., Wang, H. F., Tan, M. S., Tan, L., Xu, W., et al. (2015). Risk factors for predicting progression from mild cognitive impairment to Alzheimer’s disease: A systematic review and meta-analysis of cohort studies. Journal of Neurology, Neurosurgery, and Psychiatry, 87(5), 476–484. https://doi.org/10.1136/jnnp-2014-310095.CrossRefGoogle Scholar
- 13.Poljičanin, T., Ajduković, D., Šekerija, M., Pibernik-Okanović, M., Metelko, Ž, & Mavrinac, G. V. (2010). Diabetes mellitus and hypertension have comparable adverse effects on health-related quality of life. BMC Public Health, 10(1), 12. https://doi.org/10.1186/1471-2458-10-12.CrossRefGoogle Scholar
- 14.Trevisol, D. J., Moreira, L. B., Kerkhoff, A., Fuchs, S. C., & Fuchs, F. D. (2011). Health-related quality of life and hypertension: A systematic review and meta-analysis of observational studies. Journal of Hypertension, 29(2), 179–188. https://doi.org/10.1097/HJH.0b013e328340d76f.CrossRefGoogle Scholar
- 16.Green, A. J., Bazata, D. D., Fox, K. M., & Grandy, S. (2012). Quality of life, depression, and healthcare resource utilization among adults with type 2 diabetes mellitus and concomitant hypertension and obesity: A prospective survey. Cardiology Research and Practice. 2012. https://doi.org/10.1155/2012/404107.Google Scholar
- 20.Jekel, K., Damian, M., Wattmo, C., Hausner, L., Bullock, R., Connelly, P. J., et al. (2015). Mild cognitive impairment and deficits in instrumental activities of daily living: A systematic review. Alzheimer’s Research & Therapy, 7(1), 17. https://doi.org/10.1186/s13195-015-0099-0.CrossRefGoogle Scholar
- 22.McKhann, G. M., Knopman, D. S., Chertkow, H., Hyman, B. T., Jack, C. R., Kawas, C. H., et al. (2011). The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia, 7(3), 263–269. https://doi.org/10.1016/j.jalz.2011.03.005.CrossRefGoogle Scholar
- 23.Lee, H. Y., Hung, M. C., Hu, F. C., Chang, Y. Y., Hsieh, C. L., & Wang, J. D. (2013). Estimating quality weights for EQ-5D (EuroQol-5 dimensions) health states with the time trade-off method in Taiwan. Journal of the Formosan Medical Association, 112(11), 699–706. https://doi.org/10.1016/j.jfma.2012.12.015.CrossRefGoogle Scholar
- 26.Yang, K.-F., Hsu, C.-H., Tang, Y.-J., & Kung, C.-C. (2012). Correlation among activities of daily living, quality of life, and sense of well-being in elderly community dwellers. Taiwan Geriatrics & Gerontology, 7(4), 217–232.Google Scholar
- 27.Lawson, R. A., Yarnall, A. J., Duncan, G. W., Khoo, T. K., Breen, D. P., Barker, R. A., et al. (2014). Severity of mild cognitive impairment in early Parkinson’s disease contributes to poorer quality of life. Parkinsonism & Related Disorders, 20(10), 1071–1075. https://doi.org/10.1016/j.parkreldis.2014.07.004.CrossRefGoogle Scholar
- 28.Beerens, H. C., Zwakhalen, S. M., Verbeek, H., Ruwaard, D., & Hamers, J. P. (2013). Factors associated with quality of life of people with dementia in long-term care facilities: A systematic review. International Journal of Nursing Studies, 50(9), 1259–1270. https://doi.org/10.1016/j.ijnurstu.2013.02.005.CrossRefGoogle Scholar
- 29.Bourassa, K. J., Memel, M., Woolverton, C., & Sbarra, D. A. (2017). Social participation predicts cognitive functioning in aging adults over time: comparisons with physical health, depression, and physical activity. Aging & Mental Health, 21(2), 133–146. https://doi.org/10.1080/13607863.2015.1081152.CrossRefGoogle Scholar
- 31.Reppermund, S., Sachdev, P. S., Crawford, J., Kochan, N. A., Slavin, M. J., Kang, K., et al. (2011). The relationship of neuropsychological function to instrumental activities of daily living in mild cognitive impairment. International Journal of Geriatric Psychiatry, 26(8), 843–852. https://doi.org/10.1002/gps.2612.CrossRefGoogle Scholar
- 32.Agborsangaya, C. B., Lau, D., Lahtinen, M., Cooke, T., & Johnson, J. A. (2013). Health-related quality of life and healthcare utilization in multimorbidity: Results of a cross-sectional survey. Quality of Life Research, 22(4), 791–799. https://doi.org/10.1007/s11136-012-0214-7.CrossRefGoogle Scholar
- 35.Xu, R. H., Cheung, A. W. L., & Wong, E. L. Y. (2017). Examining the health-related quality of life using EQ-5D-5L in patients with four kinds of chronic diseases from specialist outpatient clinics in Hong Kong SAR, China. Patient Preference and Adherence, 11, 1565–1572. https://doi.org/10.2147/PPA.S143944.CrossRefGoogle Scholar
- 37.Xu, T., Clemson, L., O’Loughlin, K., Lannin, N. A., Dean, C., & Koh, G. (2018). Risk factors for falls in community stroke survivors: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation, 99(3), 563–573.e5. https://doi.org/10.1016/j.apmr.2017.06.032.CrossRefGoogle Scholar