Weight Loss and Rapid Cognitive Decline in Community-Dwelling Patients with Alzheimer's Disease

Abstract

Weight loss is a frequent complication of Alzheimer's disease (AD) and a strong predictor of adverse outcomes in patients suffering from this disease. The aim of this study was to determine whether weight loss was a predictor of rapid cognitive decline (RCD) in AD. Four hundred fourteen community-dwelling ambulatory patients with a diagnosis of probable AD and a Mini-Mental State Examination (MMSE) score between 10 and 26 from the REAL.FR (REseau sur la maladie d'ALzheimer FRançais) cohort were studied and followed up during 4 years. Patients were classified in 2 groups according to weight loss defined by a loss of 4% or more during the first year of follow-up. RCD was defined as the loss of 3 points or more in MMSE over 6 months. The incidence of RCD was determined among both groups over the last 3 years of follow-up. MMSE, Katz's Activity of Daily Living scale, Mini-Nutritional Assessment scale, co-morbidities, behavioral and psychological symptoms of dementia, medication, level of education, living arrangement, and caregiver's burden were assessed every 6 months. Eighty-seven patients (21.0%) lost 4% or more of their initial weight during the first year. The incidence of RCD for all patients was 57.6 (95% confidence interval (CI) = 51.6-64.8) per 100 person-year (median follow-up of 15.1 months). In Cox proportional hazards models, after controlling for potential confounders, weight loss was a significant predictor factor of RCD (adjusted hazard ratio (HR) = 1.50, 95% CI = 1.04-2.17). In conclusion, weight loss predicted RCD in this cohort. Whether the prevention of weight loss (by improving nutritional status) impacts cognitive decline remains an open question.

Body Mass Index Is Related to Cognitive Function in Chinese Older Adults: So What?

“…Given that our sample was selected to have no serious diseases and the statistical modeling has controlled for disease history, this small proportion of the sample could have suffered from malnutrition, as indicated by their relatively lowest CBMI. The finding was consistent with studies that examined the relation of nutrition to cognitive functions in the older adults [15,[18][19][20]29] and findings that overweight is unnecessarily related to impaired CF [30]. There are two possible explanations for their underweight.…”

Malnutrition is associated with dementia severity and geriatricsyndromes in patients with Alzheimer disease

“…It is reported that the onset of poor nutrition may be even before classical symptoms of dementia (1,2). It is crucial to screen these patients for malnutrition because poor nutrition is associated not only with a faster progression of dementia but also with adverse health problems (2,6,9,10). The MNA test is generally used to assess malnutrition in outpatient elderly (8).…”

“…Poor nutrition is also associated with worse cognition and functionality in these patients (5). Malnutrition is associated with poorer prognosis and adverse health problems in patients with dementia (2,6). Although the association of malnutrition with dementia is a well-known issue, studies involving community-dwelling AD patients from different populations are scarce.…”

“…Even the early stage of AD is associated with certain micronutrient deficiencies and a worse nutritional state compared to healthy subjects (1). Furthermore, weight loss is associated with a rapid cognitive decline in community-dwelling patients with AD (2). Malnutrition may be associated with changes in eating behavior, food intake control, and appetite in patients with dementia (3,4).…”

Comparative Study on the Influence of Epigallocatechin-3-gallat e and/ or Coenzyme Q10 against Alzheimer's disease Induced by Aluminium in Normally-Fed and Protein Malnourished Rats

“…Patients with AD have a worse nutritional status compared to others and usually suffer from malnutrition and weight loss [8,9]. In addition, weight loss was reported to predict rapid cognitive decline in AD patients [10,11]. Consequently, treatment of weight loss and malnutrition may be important to decrease the risk of AD.…”