Association Between Change in Body Mass Index, Unified Parkinson’s Disease Rating Scale Scores, and Survival Among Persons With Parkinson Disease

Wills, Anne Marie; Pérez, Adriana; Wang, Jue; Su, Xiao; Morgan, John C.; Rajan, Suja S.; Leehey, Maureen A.; Pontone, Gregory M.; Chou, Kelvin L.; Umeh, Chizoba C.; Mari, Zoltán; Boyd, James T.

doi:10.1001/jamaneurol.2015.4265

Cited by 86 publications

(67 citation statements)

References 27 publications

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“…Postural instability is associated with other forms of autonomic involvement including anosmia [18] (which was not measured in our study) and gastrointestinal disturbance (which was only measured using self-reported constipation). This correlation might also at least in part explain the association which we previously observed between decline in BMI and more rapid change in UPDRS [2]. Alternatively, it is possible that this association was due to inclusion of atypical Parkinsonian disorders which are more frequently associated with dysphagia and weight loss [19, 20].…”

Section: Discussionmentioning

confidence: 82%

“…While the majority of participants did not experience significant weight loss, a minority (7.8 %) did lose at least 5% of their body weight over the first year of the study. We have previously published that participants who experience a decline in BMI also experience a more rapid worsening of the UPDRS symptoms [2]. Thus there exists a subset of Parkinson’s patients in whom weight loss is clinically important.…”

Section: Discussionmentioning

confidence: 99%

“…Using the NINDS Exploratory Trials in PD Long-term Study-1 (NET-PD LS-1) clinical trial, we recently found that changes in body mass index (BMI) early in Parkinson’s disease are associated with changes in motor and total UPDRS scores[2]. Participants who experienced a decline in BMI (and decline in weight) also experienced a more rapid increase (worsening) in motor and total UPDRS scores compared to those whose BMI was stable, while participants whose BMI increased during the study experienced a slower increase in UPDRS.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of weight loss in early treated Parkinson’s disease from the NET-PD LS-1 cohort

Wills

Pérez³

et al. 2017

J Neurol

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Importance Weight loss is a common symptom of Parkinson’s disease and is associated with impaired quality of life. Predictors of weight loss have not been studied in large clinical cohorts. We previously observed an association between change in body mass index and change in Unified Parkinson’s Disease Rating Scale (UPDRS) motor and total scores. Objective To explore predictors of weight loss in a large prospective clinical trial cohort of early treated Parkinson’s disease. Methods Secondary analysis of longitudinal data (1–6 years) from 1619 participants in the NINDS Exploratory Trials in PD Long-term Study-1 (NET-PD LS1). This was a double-blind randomized placebo controlled clinical trial of creatine monohydrate 10 gm/day in early treated PD (within 5 years of diagnosis and within 2 years of starting dopaminergic medications). Linear mixed models were used to estimate the effect of baseline clinical covariates on weight change over time. Results On average, participants lost only 0.6 kg per year. Higher age, baseline weight, female gender, higher baseline UPDRS scores, greater postural instability, difficulty eating and drinking, lower cognitive scores and baseline levodopa use (compared to dopamine agonists) were all associated with weight loss. Surprisingly baseline difficulty swallowing, dyskinesia, depression, intestinal hypomotility (constipation) and self-reported nausea/vomiting/anorexia were not significantly associated with weight loss in this cohort of early treated Parkinson’s disease patients. Conclusions On average, participants with Parkinson’s disease experience little weight loss during the first 1–6 years after starting dopaminergic replacement therapy, however levodopa use and postural instability were both predictors of early weight loss.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of weight loss in early treated Parkinson’s disease from the NET-PD LS-1 cohort

Wills

Pérez³

et al. 2017

J Neurol

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“…A meta-analysis including 871 patients showed an overall reduction of 1.73 kg/m 2 in patients with PD compared with controls, with a positive association with disease severity but not with disease duration 90. This weight loss carries important clinical implications and appears to be associated with a more rapid disease progression91 and to correlate inversely with health-related quality of life 92…”

Section: Body Weight and Energy Metabolismmentioning

confidence: 99%

Neuroendocrine abnormalities in Parkinson's disease

Pablo-Fernández

Breen

Bouloux

et al. 2016

J Neurol Neurosurg Psychiatry

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Neuroendocrine abnormalities are common in Parkinson's disease (PD) and include disruption of melatonin secretion, disturbances of glucose, insulin resistance and bone metabolism, and body weight changes. They have been associated with multiple nonmotor symptoms in PD and have important clinical consequences, including therapeutics. Some of the underlying mechanisms have been implicated in the pathogenesis of PD and represent promising targets for the development of disease biomarkers and neuroprotective therapies. In this systems-based review, we describe clinically relevant neuroendocrine abnormalities in Parkinson's disease to highlight their role in overall phenotype. We discuss pathophysiological mechanisms, clinical implications, and pharmacological and non-pharmacological interventions based on the current evidence. We also review recent advances in the field, focusing on the potential targets for development of neuroprotective drugs in Parkinson's disease and suggest future areas for research.

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“…Given that the course of the disease is quite variable, it remains a daunting question to predict what will happen to an individual person with PD. Nevertheless, evidence suggests that rigid akinetic form, low serum urate, presence of cognitive changes, declining body mass index, and coexistent metabolic syndrome are associated with worse outcome. Neuroprotection, defined as treatments capable of effectively and completely deterring neuronal loss, remains the elusive holy grail in PD and other neurodegenerative diseases.…”

mentioning

confidence: 99%

Vitamin B12 and Parkinson's Disease: What is the Relationship?

Cardoso

2018

Movement Disorders

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Association Between Change in Body Mass Index, Unified Parkinson’s Disease Rating Scale Scores, and Survival Among Persons With Parkinson Disease

Cited by 86 publications

References 27 publications

Predictors of weight loss in early treated Parkinson’s disease from the NET-PD LS-1 cohort

Predictors of weight loss in early treated Parkinson’s disease from the NET-PD LS-1 cohort

Neuroendocrine abnormalities in Parkinson's disease

Vitamin B12 and Parkinson's Disease: What is the Relationship?

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