Prevalence of Multiple Chronic Conditions in Older Adults with Undiagnosed Mild Cognitive Impairment and Alzheimer’s Disease and Related Dementias in Primary Care

Diana Summanwar,1 Arthur H Owora,2,3 Zina Ben Miled,4 Paul R Dexter,5 Ambar Kulshreshtha,6 Samuel Strunk,2 Bowen Jiang,2 Katrina Coppedge,7 Shanell Disla,8 James E Galvin,8 Malaz Boustani,5,7,9 Nicole R Fowler5,7,9 1Department of Family Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; 2Translational Informatics, Biostatistics and Epidemiology Lab, Indiana University School of Medicine, Indianapolis, IN, USA; 3Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA; 4Phillip M. Drayer Department of Electrical and Computer Engineering, Lamar University, Beaumont, TX, USA; 5Regenstrief Institute, Indianapolis, IN, USA; 6Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA; 7Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; 8Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Boca Raton, FL, USA; 9Indiana University Center for Aging Research, Indianapolis, IN, USACorrespondence: Diana Summanwar, Department of Family Medicine, Indiana University School of Medicine, 1040 Wishard Blvd, Indianapolis, IN, 46202, USA, Tel +1 317-278-1090, Fax +317-962-5479, Email [email protected]; [email protected]: Most adults aged ≥ 65 years live with multiple chronic conditions (MCC), and nearly one in four have recognized or unrecognized Alzheimer’s disease and related dementias (ADRD), including an estimated 7.2 million Americans. Together, MCC and ADRD increase treatment complexity, medication burden, and the risk of adverse outcomes. Among patients who meet clinical criteria for mild cognitive impairment (MCI) or ADRD but lack a formal diagnosis, MCC burden remains unclear. This study examined the association between MCC burden and undiagnosed MCI and ADRD in a diverse cohort of older adults in primary care.Methods: We conducted a cross-sectional analysis of 324 adults aged ≥ 65 from primary care clinics in Indiana and South Florida (2021– 2023), as part of a larger ADRD detection study. Patients without documented MCI or ADRD completed standardized cognitive assessments. Cognitive status (normal, MCI, ADRD) was determined by interdisciplinary consensus. Chronic conditions and medications were extracted from electronic health records. Multinomial logistic regression was used to examine the association between MCC profiles and cognitive status.Results: Among 324 older adults, 51.9% were determined to have MCI and 8% ADRD. Patients with MCI and ADRD had more chronic conditions (mean = 5– 6) and medications (mean = 4– 5) than those with normal cognition (p < 0.001). Anticholinergic use was more common in the MCI (23.8%) and ADRD (23.1%) groups than in those with normal cognition (10.8%). In adjusted models, MCI and ADRD were associated with higher odds of having more chronic conditions. Cerebrovascular disease was associated with both MCI and ADRD; diabetes, sleep apnea, and insomnia with MCI; and ischemic heart disease and insomnia with ADRD.Conclusion: Older adults with unrecognized MCI and ADRD experience substantial MCC and medication burden. These findings highlight the need for targeted primary care interventions that integrate cognitive screening, support MCC management, optimize self-management capacity, and promote safer prescribing.Plain Language Summary: Many older adults live with multiple long-term health conditions and take several medications. Some also have memory or thinking problems, like mild cognitive impairment (MCI) or dementia, that have not yet been diagnosed.In this study, we looked at older adults receiving care at primary care clinics to understand how undiagnosed memory problems are related to other health issues. We found that people with unrecognized MCI or dementia had more chronic conditions and were taking more medications than those with normal memory. Certain health problems, like stroke, diabetes, and sleep disorders, were more common in people with memory issues. We also found that medications known to affect memory (called anticholinergics) were used more often in people with memory problems, especially in younger patients.These findings suggest that doctors and care teams should consider memory problems when treating older adults with complex health needs. By doing so, they can create safer care plans, choose better medications, and help patients manage their health more effectively.Keywords: mild cognitive impairment, dementia, Alzheimer disease, primary health care, comorbidity, anticholinergic agents, polypharmacy, multimorbidity, Polypharmacy, geriatric assessment