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

  • Hsin-Yun Liu
  • Wen-Che Tsai
  • Ming-Jang Chiu
  • Li-Yu Tang
  • Huey-Jane Lee
  • Yea-Ing L. ShyuEmail author



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.


Mild 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.

Ethical approval

The data were approved by the National Taiwan University Hospital’s Institutional Review Board. Informed consent was obtained from the participants or their proxy.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Healthy Aging Research CenterChang Gung UniversityTaoyuanTaiwan
  2. 2.Department of PsychiatryNational Taiwan University HospitalTaipeiTaiwan
  3. 3.Department of NeurologyNational Taiwan University HospitalTaipeiTaiwan
  4. 4.College of MedicineNational Taiwan UniversityTaipeiTaiwan
  5. 5.Graduate Institute of Brain and Mind SciencesNational Taiwan UniversityTaipeiTaiwan
  6. 6.Graduate Institute of PsychologyNational Taiwan UniversityTaipeiTaiwan
  7. 7.Graduate Institute of Biomedical Engineering and BioinformaticsNational Taiwan UniversityTaipeiTaiwan
  8. 8.Taiwan Alzheimer’s Disease AssociationTaipeiTaiwan
  9. 9.School of Nursing, College of MedicineChang Gung UniversityTaoyuanTaiwan
  10. 10.Department of Orthopedic SurgeryLinkou Chang Gung Memorial HospitalTaoyuanTaiwan
  11. 11.Department of NursingKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan
  12. 12.Department of Gerontology and Health Care ManagementChang Gung University of Science and TechnologyTaoyuanTaiwan

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