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Different modes of weight loss in Alzheimer disease: a prospective study of 395 patients^1,2,3

¹ From the Departments of Gerontology (OG, MM, RB, and PB) and Gastroenterology and Clinical Nutrition (SMS), University Hospital, Nice, France, and the Departments of Public Health (SA) and Internal Medicine and Clinical Gerontology (OG and BV), University Hospital, Institut National de la Sante et de la Recherche Medicale (INSERM) U558, Toulouse, France

Background: Alzheimer disease is often accompanied and worsened by malnutrition. Patterns of weight loss can differ by the patients concerned and by the outcome and interventions required.

Objective: Our aim was to describe and analyze 2 modes of weight loss (progressive and severe) in the course of Alzheimer disease.

Design: This was a prospective study of 395 patients with Alzheimer disease, who had a mean age of 75.4 y. A standardized gerontologic evaluation was conducted at 6 mo and 1 y, including assessments of nutrition, neuropsychology, function, and caregiver burden.

Results: We investigated 2 modes of weight loss. The first, progressive loss (4% in 1 y), affected 33.4% of subjects. Disease severity was a risk factor [odds ratio (OR): 7.2; 95% CI: 1.4, 38.2 for a Reisberg score 5], whereas treatment with cholinesterase inhibitors at baseline decreased this risk (OR: 0.33; 95% CI: 0.14, 0.79). The second mode of weight loss, a severe loss of 5 kg in 6 mo, affected 10.2% of subjects. The existence of an acute phase reaction was a risk factor (OR: 2.4; 95% CI: 1.2, 4.8), as was an intercurrent event, such as hospitalization, acute disease, institutionalization, and change of living arrangements (OR: 6.8; 95% CI: 1.2, 39.9).

Conclusion: During the follow-up of patients with Alzheimer disease, risk factors for these 2 modes of weight loss should be sought to identify patients who would benefit from a nutritional intervention. Our findings lead us to advocate follow-up, which involves an assessment of functional, nutritional, and neuropsychologic status every 6 mo.

Key Words: Weight loss • malnutrition • dementia • Alzheimer disease • aging • elderly • prospective study • malnutrition • nutritional assessment