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

Oct 30, 2025Clinical interventions in aging

Common Long-Term Health Problems in Older Adults with Undiagnosed Early Memory Loss and Dementia in Primary Care

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Abstract

Among 324 older adults, 51.9% were determined to have (MCI) and 8% had (ADRD).

Patients with MCI and ADRD had an average of 5-6 chronic conditions and 4-5 medications, significantly more than those with normal cognition.
Anticholinergic medication use was higher in the MCI (23.8%) and ADRD (23.1%) groups compared to those with normal cognition (10.8%).
In adjusted models, MCI and ADRD were linked to higher odds of having a greater number of chronic conditions.
Cerebrovascular disease was associated with both MCI and ADRD, while diabetes, sleep apnea, and insomnia were linked to MCI specifically.
Ischemic heart disease and insomnia were associated with ADRD.

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BACKGROUND: Most adults aged ≥65 years live with (MCC), and nearly one in four have recognized or unrecognized (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 (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 (< 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. p

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.

Key numbers

168 of 324

Prevalence of

Patients diagnosed with in the study cohort.

5-6

Mean Chronic Conditions

Mean number of chronic conditions for patients with and .

23.8%

Use

Percentage of patients with prescribed anticholinergic medications.

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

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