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Lookup NU author(s): Dr Calum Hamilton, Professor Fiona MatthewsORCiD, Professor Johannes Attems, Dr Paul Donaghy, Dr Daniel ErskineORCiD, Professor John-Paul TaylorORCiD, Professor Alan ThomasORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The Author(s), 2024. Published by Cambridge University Press on behalf of Royal College of Psychiatrists.Background Multimorbidity, the presence of two or more health conditions, has been identified as a possible risk factor for clinical dementia. It is unclear whether this is due to worsening brain health and underlying neuropathology, or other factors. In some cases, conditions may reflect the same disease process as dementia (e.g. Parkinson's disease, vascular disease), in others, conditions may reflect a prodromal stage of dementia (e.g. depression, anxiety and psychosis). Aims To assess whether multimorbidity in later life was associated with more severe dementia-related neuropathology at autopsy. Method We examined ante-mortem and autopsy data from 767 brain tissue donors from the UK, identifying physical multimorbidity in later life and specific brain-related conditions. We assessed associations between these purported risk factors and dementia-related neuropathological changes at autopsy (Alzheimer's-disease related neuropathology, Lewy body pathology, cerebrovascular disease and limbic-predominant age-related TDP-43 encephalopathy) with logistic models. Results Physical multimorbidity was not associated with greater dementia-related neuropathological changes. In the presence of physical multimorbidity, clinical dementia was less likely to be associated with Alzheimer's disease pathology. Conversely, conditions which may be clinical or prodromal manifestations of dementia-related neuropathology (Parkinson's disease, cerebrovascular disease, depression and other psychiatric conditions) were associated with dementia and neuropathological changes. Conclusions Physical multimorbidity alone is not associated with greater dementia-related neuropathological change; inappropriate inclusion of brain-related conditions in multimorbidity measures and misdiagnosis of neurodegenerative dementia may better explain increased rates of clinical dementia in multimorbidity
Author(s): Hamilton CA, Matthews FE, Attems J, Donaghy PC, Erskine D, Taylor J-P, Thomas AJ
Publication type: Article
Publication status: Published
Journal: British Journal of Psychiatry
Year: 2024
Pages: epub ahead of print
Online publication date: 08/04/2024
Acceptance date: 24/01/2024
Date deposited: 25/01/2024
ISSN (print): 0007-1250
ISSN (electronic): 1472-1465
Publisher: Cambridge University Press
URL: https://doi.org/10.1192/bjp.2024.25
DOI: 10.1192/bjp.2024.25
Data Access Statement: All relevant data (de-identified) from the Brains for Dementia Research (BDR) cohort are held within the Dementias Platform UK repository and the UK Brain Banks Network. Analytical scripts to replicate the findings presented in this paper are available from the corresponding author on request.
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