Weight loss in Alzheimer's disease, vascular dementia and dementia with Lewy bodies: Impact on mortality and hospitalization by dementia subtype

Abstract

Objectives Loss of weight is associated with cognitive decline as well as several adverse outcomes in dementia. The aim of this study was to assess whether weight loss is associated with mortality and hospitalization in dementia subtypes. Methods A cohort of 11,607 patients with dementia in Alzheimer's disease (AD), vascular dementia (VD), or dementia with Lewy bodies (DLB) was assembled from a large dementia care health records database in Southeast London. A natural language processing algorithm was developed to established whether loss of weight was recorded around the time of dementia diagnosis. Cox proportional hazard models were applied to examine the associations of reported weight loss with mortality and emergency hospitalization. Results Weight loss around the time of dementia was recorded in 25.5% of the whole sample and was most common in patients with DLB. A weight loss‐related increased risk for mortality was detected after adjustment for confounders (Hazard ratio (HR):1.07; 95% confidence interval (CI):1.02–1.15) and in patients with AD (HR: 1.11; 95% CI: 1.04–1.20), but not in DLB and VD. Weight loss was associated with a significantly increased emergency hospitalization risk (HR: 1.14; 95% CI: 1.08–1.20) and in all three subtypes. Conclusions While there were associations with increased hospitalization risk for all three subtype diagnoses, weight loss was only associated with increased mortality in AD. Weight loss should be considered as an accompanying symptom in dementia and interventions should be considered to ameliorate risk of adverse outcomes.

The prevalence and co-existence of geriatric syndromes in older patients with dementia compared to those without dementia

“…Dysphagia and malnutrition are more common in dementia patients [ 12 ]. The relationship between dementia and malnutrition is complex and people with dementia might be more prone to losing weight for several reasons, including difficulties in activities of daily living, such as shopping and cooking, which may limit food consumption [ 13 ]. Further, malnutrition may be affected by behavioral and psychological symptoms of dementia by both reducing food intake and physical activity [ 14 ].…”

Predictors of two-year mortality in patients with dementia with Lewy bodies

“…In dementia, the presence of malnutrition complicates the management of patients by increasing the risk of developing geriatric syndrome as well as impairing functionality, reducing quality of life, and leading to an increased risk of death [ 27 ]. In addition, the relationship between DLB and malnutrition was examined in two studies [ 27 , 28 ]. DLB patients had 6.83 times increased risk of malnutrition compared to those with other types of dementia [ 28 ].…”

Functional loss and worsening geriatric assessment parameters are more common in dementia with Lewy bodies than Alzheimer's disease

“…Therefore, comparative studies of dementia subtypes have increased in recent years. [18][19][20] For example, the two most common dementia types in older adults are AD and DLB, with the latter having higher mortality (average survival time in DLB from diagnosis being 4.11 years versus 5.66 years in AD), equating to a 1.55-year shorter survival in DLB. 3 In addition, caregiver burden for DLB patients is higher than for AD patients for two important reasons.…”

“…Although the diagnosis of dementia is important for an older patient and his/her caregiver to aid in management, the dementia subtype is of equal importance for care management, because neuropsychiatric symptoms, the affected neurocognitive domains, prognosis of the disease, caregiver burnout, and survival times may differ in each dementia subtype. Therefore, comparative studies of dementia subtypes have increased in recent years 18–20 . For example, the two most common dementia types in older adults are AD and DLB, with the latter having higher mortality (average survival time in DLB from diagnosis being 4.11 years versus 5.66 years in AD), equating to a 1.55‐year shorter survival in DLB 3 .…”

“…It is not surprising that the tendency for malnutrition is high in DLB, the reasons for which are the prolonged duration of swallowing food and liquids as extrapyramidal symptoms are likely to cause eating and swallowing problems, higher frequencies of anorexia and constipation in DLB than AD, and decreased energy intake due to the more frequent occurrence of neuropsychiatric symptoms such as hallucinations, delusions, depression, irritability, abnormal motor behaviour, and decreased social interaction in DLB leading to a reduction in adequate energy consumption 18,20 . Among the laboratory parameters, the fact that albumin is lower in DLB than in AD also supports this finding.…”