Nutritional status assessment in Alzheimer disease and its influence on disease progression

E Izquierdo Delgado; R Gutiérrez Ríos; M Andrés Calvo; I Repiso Gento; A Castrillo Sanz; R Rodríguez Herrero; M F Rodríguez Sanz; M A Tola-Arribas

doi:10.1016/j.nrl.2019.11.005

Nutritional status assessment in Alzheimer disease and its influence on disease progression

Neurologia (Engl Ed). 2020 Jan 21:S0213-4853(19)30148-3. doi: 10.1016/j.nrl.2019.11.005. Online ahead of print.

[Article in English, Spanish]

Authors

E Izquierdo Delgado¹, R Gutiérrez Ríos², M Andrés Calvo¹, I Repiso Gento³, A Castrillo Sanz², R Rodríguez Herrero⁴, M F Rodríguez Sanz², M A Tola-Arribas⁵

Affiliations

¹ Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, España.
² Sección de Neurología, Complejo Asistencial de Segovia, Segovia, España.
³ Medicina de Familia, Área Sanitaria Valladolid Oeste, Valladolid, España.
⁴ Sección de Geriatría, Complejo Asistencial de Segovia, Segovia, España.
⁵ Sección de Neurología, Hospital Universitario Río Hortega, Valladolid, España. Electronic address: mtoar@saludcastillayleon.es.

PMID: 31980283
DOI: 10.1016/j.nrl.2019.11.005

Abstract

Introduction: Nutritional deficiencies are frequent in Alzheimer disease (AD), even in early stages. Nutritional impairment (NI) may be associated with faster disease progression. The objective of this study was to describe the frequency of NI and the associated risk factors at the time of diagnosis and to analyse its influence on subsequent progression.

Methods: We performed a prospective, multicentre, observational study of patients recently diagnosed with prodromal AD (pAD) or dementia due to AD (ADd). Two clinical assessments were conducted over a period of 18months. The Mini Nutritional Assessment test (MNA; score range, 0-30; cut-off point for NI, <24) was used to estimate nutritional status. Progression was defined as an increase of ≥3points on the Clinical Dementia Rating-sum of boxes test.

Results: The sample included 50 patients with pAD (mean [standard deviation] age, 76.1 [5.3] years; 68% women), and 127 with ADd (80 [5.9] years; 72.4% women). A total of 141 (79.7%) completed both evaluations. The prevalence of NI was 28.2% (24% for pAD, 29.9% for ADd; P=.43), with the majority (92%) at risk of malnutrition. NI was associated with female sex (odds ratio [OR]: 4.2; 95% confidence interval [CI]: 1.7-10.5; P<.001) and greater behavioural involvement (OR: 5.8; 95%CI: 2.6-12.7; P<.001). A larger proportion of patients with progression was observed among those with NI than among those with normal nutritional status (50% vs 28.7%, P<.05; ADd: 53.6% vs 31.8%, P<.05; pAD: 41.7% vs 22.9%, P=.21). Greater cognitive impairment (OR: 2.1; 95%CI: 1.03-4.4; P<.05) and NI (OR: 2.4; 95%CI: 1.1-5.1; P<.05) were independent risk factors for disease progression.

Conclusions: NI is highly prevalent in patients with AD. Assessing nutritional status at the time of diagnosis may enable identification of patients at greater risk of disease progression.

Keywords: Alzheimer disease; Demencia; Dementia; Enfermedad de Alzheimer; Estado nutricional; Estudio prospectivo; Nutritional status; Prevalence; Prevalencia; Prospective study.