Does l-dopa treatment contribute to reduction in body weight in elderly patients with Parkinson's disease?

Pålhagen, Sven; Lorefält, Birgitta; Carlsson, Maine; Ganowiak, Wojchiec; Toss, Göran; Unosson, Mitra; Granérus, Ann‐Kathrine

doi:10.1111/j.1600-0404.2004.00364.x

Cited by 60 publications

(51 citation statements)

References 15 publications

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“…We are lacking data on food intake, hunger, or appetite and motivational salience attribution before surgery, and we can hardly exclude the effect of medication (antidepressants, dopamine agonists, levodopa decrease) on between-group comparisons and on the body weight of PD patients. [54][55][56] Despite its drawbacks, the present study suggests that STN DBS activates the aversive motivational system in a way that more emotional relevance is attributed to fearful aversive stimuli. Our results further suggest that body weight gain in PD patients treated by STN DBS might be related to increased sensitivity to food reward cues, which may be of practical value for managing this side effect.…”

Section: S T N D B S a F F E C T S M O T I V A T I O N A L P R O C E mentioning

confidence: 86%

Subthalamic nucleus stimulation affects incentive salience attribution in Parkinson's disease

et al. 2011

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Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can induce nonmotor side effects such as behavioral and mood disturbances or body weight gain in Parkinson's disease (PD) patients. We hypothesized that some of these problems could be related to an altered attribution of incentive salience (ie, emotional relevance) to rewarding and aversive stimuli. Twenty PD patients (all men; mean age ± SD, 58.3 ± 6 years) in bilateral STN DBS switched ON and OFF conditions and 18 matched controls rated pictures selected from the International Affective Picture System according to emotional valence (unpleasantness/pleasantness) and arousal on 2 independent visual scales ranging from 1 to 9. Eighty-four pictures depicting primary rewarding (erotica and food) and aversive fearful (victims and threat) and neutral stimuli were selected for this study. In the STN DBS ON condition, the PD patients attributed lower valence scores to the aversive pictures compared with the OFF condition (P < .01) and compared with controls (P < .01). The difference between the OFF condition and controls was less pronounced (P < .05). Furthermore, postoperative weight gain correlated with arousal ratings from the food pictures in the STN DBS ON condition (P < .05 compensated for OFF condition). Our results suggest that STN DBS increases activation of the aversive motivational system so that more relevance is attributed to aversive fearful stimuli. In addition, STN DBS-related sensitivity to food reward stimuli cues might drive DBS-treated patients to higher food intake and subsequent weight gain.

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Section: S T N D B S a F F E C T S M O T I V A T I O N A L P R O C E mentioning

confidence: 86%

Subthalamic nucleus stimulation affects incentive salience attribution in Parkinson's disease

et al. 2011

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“…Patients with Parkinson's disease (PD) tend to lose weight progressively at a rate which corresponds to the stage of their disease [1][2][3]. Similarly, patients with essential tremor (ET) have lower body mass index (BMI) scores compared to controls, and these lower scores have correlated with disease of greater severity and longer duration [4].…”

Section: Introductionmentioning

confidence: 97%

Weight change following deep brain stimulation for movement disorders

et al. 2010

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Patients with Parkinson's disease (PD) and essential tremor (ET) tend to lose weight progressively over years. Weight gain following deep brain stimulation (DBS) of the subthalamic nucleus (STN) for treatment of PD has been documented in several studies that were limited by small sample size and exclusive focus on PD patients with STN stimulation. The current study was undertaken to examine weight change in a large sample of movement disorder patients following DBS. A retrospective review was undertaken of 182 patient charts following DBS of the STN, ventralis intermedius nucleus of the thalamus (VIM), and globus pallidus internus (GPi). Weight was collected preoperatively and postoperatively up to 24 months following surgery. Data were adjusted for baseline weight and multivariate linear regression was performed with repeated measures to assess weight change. Statistically significant mean weight gain of 1.8 kg (2.8% increase from baseline, p = 0.0113) was observed at a rate of approximately 1 kg per year up to 24 months following surgery. This gain was not predicted by age, gender, diagnosis, or stimulation target in a multivariate model. Significant mean weight gain of 2.3 kg (p = 0.0124) or 4.2% was observed in our PD patients. Most patients with PD and ET gain weight following DBS, and this gain is not predicted by age, gender, diagnosis, or stimulation target.

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“…In a previous report, we raised the question of whether treatment with L-dopa could be a contributing factor to weight loss. 5 However, weight loss is reported to start before treatment. 3,5 Energy intake increases in patients losing weight 6 but no change in resting energy expenditure has been found.…”

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confidence: 98%

“…5 However, weight loss is reported to start before treatment. 3,5 Energy intake increases in patients losing weight 6 but no change in resting energy expenditure has been found. 4,7 PD-symptoms were found to be more severe in patients with weight loss, which could be an expression of a more severe neuro-degeneration.…”

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confidence: 98%

Weight loss, body fat mass, and leptin in Parkinson's disease

2009

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Weight loss is a common problem in Parkinson's disease (PD), but the causative mechanisms behind this weight loss are unclear. We compared 26 PD patients with sex and age matched healthy controls. Examinations were repeated at baseline, after one and after two years. Body fat mass was measured by Dual X-ray Absorptiometry (DXA). Seventy three per cent of the PD patients lost body weight. Loss of body fat mass constituted a considerable part of the loss of body weight. In the patients who lost weight, serum leptin levels were lower than in those who did not lose weight. The relationship between low body fat mass and low leptin levels seems to be relevant, at least for female PD patients. It is reasonable to believe that low leptin levels in these patients could be secondary to the decreased body fat mass.

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Does l-dopa treatment contribute to reduction in body weight in elderly patients with Parkinson's disease?

Abstract: The underlying disease could play a role, but our results also suggest that L-dopa per se could contribute to the weight loss.

Cited by 60 publications

References 15 publications

Subthalamic nucleus stimulation affects incentive salience attribution in Parkinson's disease

Subthalamic nucleus stimulation affects incentive salience attribution in Parkinson's disease

Weight change following deep brain stimulation for movement disorders

Weight loss, body fat mass, and leptin in Parkinson's disease

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