# Comorbidities predict institutionalization and mortality in biomarker-confirmed alzheimer’s disease

## TL;DR

This study finds that certain health conditions like diabetes and heart disease are linked to faster cognitive decline, higher chances of institutionalization, and increased mortality in Alzheimer's patients confirmed by biomarkers.

## Contribution

The study identifies specific comorbidities that predict institutionalization and mortality in biomarker-confirmed Alzheimer’s disease.

## Key findings

- Type-2 diabetes and ischemic heart disease are associated with cognitive deterioration in Alzheimer’s disease.
- Mental disorders, type-2 diabetes, and stroke increase the risk of institutionalization.
- Endocrine-metabolic disorders, circulatory diseases, and chronic kidney disease are linked to higher mortality rates.

## Abstract

We explored the associations of comorbidities with cognitive deterioration, institutionalization, and mortality in biomarker-confirmed Alzheimer’s disease (AD) dementia.

We conducted a Swedish Register-based cohort study consisting of 10,857 people (mean age 74 years) with diagnosed dementia and positive AD biomarkers (CSF Aβ42/P-tau181 ratio). Cognitive function was measured by mini-mental state examination (MMSE). Comorbidities by human body organ systems (e.g., diseases of the circulatory system) and six selected comorbidities: type-2 diabetes (T2DM), ischemic heart disease (IHD), stroke, chronic kidney disease (CKD), inflammatory bowel disease, and depression, were analyzed. Multistate Cox regressions assessed the associations of comorbidities with cognitive deterioration, institutionalization, and death.

Only T2DM and IHD were associated with cognitive deterioration. Mental disorders, T2DM, and stroke were linked to higher hazards of institutionalization. Endocrine-metabolic disorders, circulatory system diseases, and CKD were associated with higher mortality rates.

Comorbidities may help inform the prognosis of biomarker-confirmed AD dementia.

The online version contains supplementary material available at 10.1186/s13195-025-01807-6.