AbstractBackgroundMultimorbidity is the concurrent occurrence of two or more chronic diseases, with severe multimorbidity (abbreviated here as SMM) meaning three or more. Patients have chronic diseases that fall into different domains (e.g., cardiovascular or endocrine), and many of these diseases themselves, such as diabetes, contribute to the onset and progression of cognitive decline. Chronic diseases may interact, curtailing compensatory mechanisms and increasing the likelihood of physical and cognitive decline. Physicians often miss diagnoses of cognitive decline when addressing SMM, while cognitive decline, in turn, can reduce a person’s ability to manage SMM. This becomes a vicious cycle.MethoduMETHOD Health has developed a CDSS platform to address cognitive decline (i.e., dementia, MCI, and mild AD) through the creation of personalized, multidomain treatment plans. Across a population of 2,079 individual 65 years or older, the platform evaluated 19 chronic disease conditions (the three most frequent: CKD, hypertension, and dyslipidemia), plus diseases detected in CBC serum analysis (such as macrocytosis and thrombocytopenia) and CMP serum analysis (such as hypercupremia and hypernatremia). Disease status was determined by physicians’ diagnoses or by the software, through analyzing lab reports, vital signs, medications, and medical status.ResultIn this population, 7.2% individuals had no comorbid chronic diseases. 64.5% had three or more chronic diseases (that is, SMM), with two people having 14 concurrently (mean: 3.85 chronic diseases, std: 2.63). 64.3% of the 2,079 had cognitive decline. A symmetry (by coincidence) emerged when considering cognitive decline: 75% of those with SMM had cognitive decline; 75% of those with cognitive decline had SMM. Lastly, the percentage of people with cognitive decline increased as the number of concurrent chronic diseases increased.ConclusionTreatment plans for cognitive decline are already multivariable, and must address multidomain SMM as part of their coverage. Neurologists need processes for developing comprehensive care plans that address cognitive decline and comorbidities in concordance, and coordinating care with other physicians simultaneously caring for a given patient. This CDSS platform generates effective and highly‐usable guidelines for identifying and prioritizing concurrent chronic diseases, and giving guidance on the total picture: what needs to happen, how, and when.
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