Date of Award:


Document Type:


Degree Name:

Doctor of Philosophy (PhD)



Committee Chair(s)

JoAnn T. Tschanz


JoAnn T. Tschanz


M. Scott DeBerard


Maria C. Norton


Elizabeth Fauth


Christopher Corcoran


Alzheimer’s disease is a progressive disease that impairs cognitive and functional abilities. Currently, there is no cure and it is estimated there will be 81 million cases of Alzheimer’s disease by 2040. Life for the individual with Alzheimer’s disease, and their family, changes drastically when the affected individual experiences significant impairments in cognitive or functional ability (severe dementia), is placed in a skilled nursing home facility (institutionalization), or passes away (death). Until a cure is discovered, it will be important to identify modifiable factors that influence progression to severe dementia, institutionalization, and death. Three hundred thirty-five participants who were living in the community were followed after the onset of Alzheimer’s disease and continued until they left the study or the study period ended. Participants completed neuropsychological assessments at each visit. Visits occurred as close to every 6 months as possible and the mean number of visits was 5.32 (SD = 3.46). Outcomes of interest were severe dementia, institutionalization, and death. Predictor variables were hypertension, stroke, congestive heart failure, number of prescription medications being taken, General Medical Health Rating (GMHR) score, and Charlson Comorbidity Index score. Cox Regression was utilized to identify associations with progression to the specified outcomes. GMHR score, congestive heart failure, and number of prescription medications were associated with progression to severe dementia. The number of prescription medications was also associated with nursing home placement. GMHR score, stroke, and number of prescription medications were associated with death. These findings are important because they contribute to a better understanding of how measures of medical health, certain medical conditions, and potentially their prevention or treatment may help those with Alzheimer’s disease sustain a higher quality of life.