Nutritional status and dietary habits in Parkinson’s disease patients in Ghana

ObjectiveDietary treatment is important for the management of Parkinson’s disease (PD). Our objective was to describe the dietary habits and assess the nutritional status of Ghanaian patients with PD. This study is part of a larger project, for which Ghana has been selected as a pilot country.MethodsFifty-five Ghanaian patients with PD and 12 healthy Ghanaian controls were recruited. We assessed nutritional status, investigated dietary habits, and assessed the prevalence of the nutritional complications of PD (e.g., constipation and dysphagia).ResultsThe mean daily caloric intake was about 1200 kcal/d in patients with PD and in controls. The typical diet was based on semisolid foods, usually vegetable soups accompanied by cereal flour or root starch or sometimes chicken or fish. The intake of milk and its derivatives was low. The prevalences of constipation and dysphagia in patients with PD were 49% and 21%, respectively.ConclusionThis study has yielded information that could be useful for the study of the management of PD and for the assessment of response to therapy.     

The nutritional status of Dutch elderly patients with Parkinson’s disease

Objectives: To assess the prevalence of (risk of) undernutrition in Dutch elder Parkinson’s disease patients as well as it’s risk factors. Design: Observational cross-sectional study. Setting: An outpatient clinic at the department Neurology of Medical Centre Leeuwarden, a large teaching hospital. Participants: 102 outpatients with Parkinson’s disease aged 65 years and older were recruited. Measurements: Data regarding various aspects of undernutrition including socio-demographic aspect, disease characterisitics, nutritional status, appetite and overall-physical and psychological functioning were collected. Results: Undernutrition was diagnosed in 2.0% and 20.5% of the patients were categorized as being at risk of undernutrition. Care dependency and appetite were the two risk factors with the highest predictive value for an unfavorable nutritional status. Conclusion: Of Dutch elderly patients with Parkinson’s Disease 22.5% had an unfavourable nutritional status. Dependency and appetite were the two risk factors with the highest predictive value fort his outcome. Because undernutrition can be regarded as a geriatric syndrome a comprehensive nutritional assessment should be done followed by nutritional interventions next to interventions focused on the risk factors. Further studies are needed to evaluate these interventions.     

Ghrelin and leptin secretion in patients with moderate Alzheimer’s disease

Background

Weight loss is a characteristic finding of patients with Alzheimer??s disease (AD). It seems that precedes cognitive impairment by some years, but the underlying causes are not fully understood. Ghrelin and leptin are involved in energy homeostasis, and may be implicated in weight losing observed in these patients.

Objective

To examine the potential relationship between ghrelin and leptin levels and weight loss in patients with AD.

Design

The study included 27 patients (10 men and 17 women) with AD of moderate severity, and 23 controls (10 males and 13 females), matched for age and BMI. Body fat and lean mass content were assessed using a portable apparatus. Cognitive function was assessed with the Mini-Mental State Examination. Basal serum samples for the measurement of leptin, ghrelin, insulin and glucose were obtained, and serum ghrelin, insulin and glucose were measured after a 75-gr glucose load in both groups.

Results

Patients with Alzheimer Disease (AD) have lower lean mass content compared to controls. Basal ghrelin and leptin is similar in patients with AD and controls. The area-under-the-curve for ghrelin (AUC) is lower in male patients with AD compared to control males, while no difference was observed between females AD and controls.

Conclusion

Male patients with AD, in contrast with female patients, fail to maintain a normal energy homeostasis even in the early stages of the disease, as shown by the decreased lean mass content in males AD compared to controls. Disruption of the normal compensatory modulation of ghrelin secretion might contribute to the metabolic changes observed in male patients with AD.     

Nutritional status of community-dwelling elderly with newly diagnosed Alzheimer’s disease: Prevalence of malnutrition and the relation of various factors to nutritional status

Objetives

To determine the prevalence of malnutrition and its relation to various factors in community-dwelling elderly with newly diagnosed Alzheimer’s disease (AD).

Design

Retrospective crosssectional study.

Setting

Memory clinic in a rural part of the Netherlands.

Participants

312 Community-dwelling AD patients, aged 65 years or older, were included.

Measurements

At the time the diagnosis AD was made, socio-demographic characteristics and data on nutritional status (Mini Nutritional Assessment (MNA)), cognitive function (Mini Mental State Examination (MMSE), Cambridge Cognitive Examination (Camcog)), functional status (Interview for Deterioration in Daily Living Activities in Dementia (IDDD), Barthel Index (BI)) and behaviour (Revised Memory and Behaviour Problems Checklist (RMBPC)) were assessed. Characteristics of well-nourished patients (MNA score >23.5) were compared to characteristics of patients at risk of malnutrition (MNA score 17–23.5). Linear regression analysis was performed to assess the effect of various factors on nutritional status.

Results

The prevalence of malnutrition was 0% and 14.1% was at risk of malnutrition. AD patients at risk of malnutrition were more impaired in basic and complex daily functioning than well-nourished AD patients (median IDDD score 41.5 [25th–75th percentile 38.8–48.0] versus median IDDD score 40.0 [25th–75th percentile 37.0–43.0], p = 0.028). The degree of impairment in basic and complex daily functioning (IDDD) was independently related to nutritional status (MNA) (p = 0.001, B = ?0.062).

Conclusion

One in seven community-dwelling elderly with newly diagnosed AD is at risk of malnutrition. The degree of impairment in daily functioning is independently related to nutritional status. Therefore, assessment of the nutritional status should be included in the comprehensive assessment of AD patients. The relation between daily functioning, nutritional status and AD warrants further investigation.     

Cardiometabolic factors and disease duration in patients with Parkinson’s disease

ObjectivePrevious studies have reported that patients with Parkinson’s disease (PD) have a favorable cardiometabolic risk profile. The aim of this study was to investigate the relationship between cardiometabolic risk factors and the duration of disease.MethodsOne hundred and fifty patients with PD (56.7% men) were studied, measuring body mass index (BMI), waist circumference (WC), body fat percentage (BF%) by impedance, fasting glucose, serum lipids, and transaminases.ResultsIn sex- and age-adjusted correlation models, duration of PD was inversely related to BMI (r = ?0.20; P < 0.05) and BF% (r = ?0.29; P < 0.005). Using multivariable regression models (adjustments: age, gender, smoking status, levodopa dose and, alternatively, BMI, WC, or BF%), high-density lipoprotein (HDL) levels were positively correlated with disease duration (P < 0.01 for all). In models adjusted for WC and BF%, total HDL-cholesterol ratio was also inversely associated with duration of PD (P < 0.05 for both). No other association between biochemical variables and the duration of PD was found. Moreover, no dose–response effect of levodopa on metabolic risk factors was observed.ConclusionsHDL levels and total HDL-cholesterol ratio were favorably associated with duration of PD. This factor may contribute to cardiometabolic protection in PD. The mechanisms underlying this association deserve further investigation.     

Nutritional status in Parkinson’s disease patients undergoing deep brain stimulation surgery: A pilot study

Objectives

People with Parkinson’s disease (PD) are at higher risk of malnutrition due to PD symptoms and pharmacotherapy side effects. When pharmacotherapy is no longer effective for symptom control, deep-brain stimulation (DBS) surgery may be considered. The aim of this study was to assess the nutritional status of people with PD who may be at higher risk of malnutrition related to unsatisfactory symptom management with optimised medical therapy.

Design

This was an observational study using a convenience sample.

Setting

Participants were seen during their hospital admission for their deep brain stimulation surgery.

Participants

People with PD scheduled for DBS surgery were recruited from a Brisbane neurological clinic (n=15).

Measurements

The Patient-Generated Subjective Global Assessment (PG-SGA), weight, height and body composition were assessed to determine nutritional status.

Results

Six participants (40%) were classified as moderately malnourished (SGA-B). Eight participants (53%) reported previous unintentional weight loss (average loss of 13%). On average, participants classified as well-nourished (SGA-A) were younger, had shorter disease durations, lower PG-SGA scores, higher body mass (BMI) and fat free mass indices (FFMI) when compared to malnourished participants (SGA-B). Five participants had previously received dietetic advice but only one in relation to unintentional weight loss.

Conclusion

Malnutrition remains unrecognised and untreated in this group despite unintentional weight loss and presence of nutrition impact symptoms. Improving nutritional status prior to surgery may improve surgical outcomes.     

Postural stability in Parkinson’s disease patients’ wives and in elderly women leading different lifestyles

Abstract

The study aimed to determine postural stability of Parkinson’s disease (PD) patients’ wives in comparison with women differing in their lifestyle. (PD) patients’ wives (n?=?44), homemakers (n?=?41), and female students of the University of the Third Age (n?=?43) performed balance tests on a stabilometric platform. The PD patients’ wives were characterized by significantly (p?<?0.001) higher values of mean velocity sway than the homemakers and students (approximately 3.5 and 5?mm/s, respectively) and performed worst in displacement velocity and sway range in both sagittal and frontal plane. The results indicate that the wives of PD patients need support in the area of health training targeted at improving their standing stability.     

Bioelectrical impedance vector analysis detects low body cell mass and dehydration in patients with Alzheimer’s disease

Objectives  

This paper evaluates the nutritional status in patients with mild-moderate and severe Alzheimer’s disease (AD) by bioelectrical impedance vector analysis (BIVA).     

Neuroticism and extraversion in association with quality of life in patients with Parkinson’s disease

Purpose  Personality traits appear as determinants of quality of life (QoL) in most chronic diseases. The aim of this study is to explore whether neuroticism and extraversion contribute to the variance in QoL in patients with Parkinson’s disease (PD) when controlled for age, functional status and disease duration. Methods  The Parkinson’s Disease Quality of Life Questionnaire (PDQ-39) was used to assess QoL and the Unified Parkinson’s Disease Rating Scale (UPDRS) for disease severity. Neuroticism and extraversion were measured with the Eysenck Personality Questionnaire (EPQR-A). Multiple linear regression analysis was then used to assess the contribution of neuroticism and extraversion to QoL. Results  The sample consisted of 153 PD patients (48.4% women; 67.9 ± 9.3 years; mean disease duration 7.5 ± 5.8 years). Neuroticism was, after disease severity, the second most important variable associated with QoL in PD patients, in particular for domains associated with psychological processes: emotional well-being, social support, stigma and communication. A higher score in extraversion was significantly associated with better emotional well-being in males, but surprisingly, with worse emotional well-being in females. Conclusions  After functional status, personality traits were clearly associated with QoL in PD patients. Therefore, they should be taken into account by health-care professionals in their appraisal of patient complaints.     

Transforming growth factor beta and soluble endoglin in the healthy senior and in Alzheimer’s disease patients

Objectives  

Senescence of the immune system and of endothelial cells can contribute to age-dependent vascular and neurodegenerative disorders including Alzheimer’s disease. The aim of this study is an assessment of putative relationships of serum levels of transforming growth factor beta (TGFβ) and soluble endoglin (sCD105) and neurodegeneration, and of changes of these molecules in the course of ageing.     

Cerebrovascular disease and gait and balance impairment in mild to moderate Alzheimer’s disease

Objectives

Gait and movement abnormalities are traditionally considered infrequent in patients with mild/moderate Alzheimer’s disease (AD). However, an increased risk of falls and gait abnormalities has been detected, even in early stages of the disease. Whether these abnormalities are associated with cerebrovascular disease, which has a high prevalence in AD, remains unclear.

Design

Cross-sectional study.

Setting

Dementia outpatient clinics.

Participants

24 mild/moderate AD patients with (AD+CVD) and 20 without (AD-CVD) cerebrovascular disease without a history of stroke and antipsychotic medications.

Measurements

Physical performance, measured with the Short Physical Performance Battery [SPPB], a summary measure combining 4-meter gait speed, balance and muscle strength, and with 8-meter gait speed with a turn was compared between the two groups.

Results

AD+CVD patients showed a significant higher prevalence of 4-meter gait speed slower than 0,8 m/s (37.5% Vs 5%, p-value=0.01) and balance impairment (37.5% Vs 10%, p-value=0.038), as well as a slower 8-meter gait speed with a turn (mean+SD=0.6±0.2 Vs 0.8±0.2, p-value=0.024). These associations were confirmed in multivariable models. No differences were observed for muscle strength.

Conclusion

In our sample, AD with cerebrovascular disease had worse gait and balance than AD without cerebrovascular disease. If confirmed, these results may have clinical implications, since cerebrovascular disease can be potentially prevented.     

Potential cost-effectiveness of a family-based program in mild Alzheimer’s disease patients

Alzheimer’s disease (AD) is a chronic and progressive neurodegenerative disease characterized by a progressive deterioration in cognitive functions. AD will have a major impact on public health in the coming decades. The objective of this study was to evaluate the potential cost-effectiveness of a cognitive-behavioral family intervention (CBFI) program in patients with mild Alzheimer’s disease in Finland. A second-order Monte Carlo technique was used to simulate the effectiveness of the intervention in AD patients and their informal caregivers over the course of 5 years. A Bayesian approach was applied to answer the question: how likely is it that the CBFI program is cost-effective? Based on existing information, the incremental net health benefit of the CBFI program is positive with over 0.9 probability, which indicates that the CBFI program has the highest probability of being optimal by providing greater net benefits than current practice. Furthermore, changes in the health-related quality of life of the caregivers were insensitive to AD patients’ disease stage and settings of care. From the methodological point of view, the acceptability curve with a Bayesian approach provides a flexible way to characterize uncertainty surrounding cost-effectiveness parameters.     

Disease progression and costs of care in Alzheimer’s disease patients treated with donepezil: a longitudinal naturalistic cohort

Background/Aims

Improved data and methods are needed for modeling disease progression in Alzheimer’s disease (AD) for economic evaluation of treatments. The aim is to estimate prediction models for long-term AD progression and subsequently economic outcomes.

Methods

Three-year follow-up data on 435 patients treated with the cholinesterase inhibitor donepezil in clinical practise were analyzed. Regression models were estimated for long-term prediction of decline in cognitive function (ADAS-cog) and activities in daily living (ADL) ability, risk of institutionalization and costs of care.

Results

The cognitive deterioration was estimated at between 1.6 and 4 ADAS-cog points per every 6?months, increasing with disease severity. Cognitive function was an important predictor of ADL-ability, which itself was the most important predictor of the risk of institutionalization and costs of care. Combining all models in a cross-validation process generated accurate predictions of costs of care at each 6?months follow-up.

Conclusion

The proposed methods for representing AD progression and economic outcomes can be used in micro-simulation models for the economic evaluation of new treatments.     

Quality of life in Serbian patients with Parkinson’s disease

Background  The Parkinson’s Disease Questionnaire (PDQ-39) is a well-validated British scale for the assessment of health-related quality of life (QoL) in Parkinson’s disease (PD). Objective  To validate the Serbian version of the PDQ-39, while also providing additional information on the characteristics of this instrument. Patient and methods  A total of 102 Serbian PD patients were asked to complete the PDQ-39, a disease-specific QoL questionnaire, as well as the generic, health status questionnaire (SF-36-version 1), and the 21-item Beck Depression Inventory. Neurological examination included the Hoehn and Yahr staging, Unified Parkinson’s disease rating scale (UPDRS)-part III, Schwab and England scale, and the Mini-Mental State Examination. Results  Internal consistency analysis yielded a Cronbach’s α of 0.83. Cronbach’s α was above 0.70 for seven out of eight subscales (range from 0.73 to 0.91). A hierarchical structure of the PDQ-39 was revealed, with one global higher-order factor and two lower-order factors. The strongest predictor of the QoL in PD was the presence of depression, while motor disability (UPDRS-part III score) additionally contributed to poor QoL. Cognitive impairment has not been correlated with poor QoL. Also, QoL measures were not different between young- (≤50 years) and older-onset PD patients. Conclusions  The PDQ-39 is a reliable and valid instrument for the assessment of QoL in Serbian PD patients.     

Type D, anxiety and depression in association with quality of life in patients with Parkinson’s disease and patients with multiple sclerosis

Purpose

The present study examines the role of Type D personality, anxiety and depression in quality of life (QoL) in patients with two chronic neurological diseases—Parkinson’s disease (PD) and multiple sclerosis (MS).

Methods

This cross-sectional study included 142 PD patients (73 % males; mean age 67.6 ± 9.2 years) and 198 patients with MS (32.3 % males; 38.4 ± 10.8 years). Multiple regression analyses were used to analyze the association of UDPRS (PD patients) or EDSS (MS patients), Type D personality (DS-14) and anxiety and depression (HADS) with the physical (PCS) and mental summary (MCS) of QoL, as measured by the SF-36.

Results

In PD patients, Type D was significantly associated with MCS only; in MS patients, Type D was significantly associated with both dimensions—MCS and PCS. After adding anxiety and depression, the importance of Type D for the QoL model dramatically decreased. Anxiety and depression were strongly associated with lower scores in MCS and PCS in both PD and MS patients.

Conclusions

The actual mood of PD and MS patients—the level of anxiety or depression—might have a greater impact on patients’ QoL than their personality. Further longitudinal research should focus on how the pathway consisting of personality traits, anxiety and depression, and QoL might be constructed.     

Nutritional status in chronically-ill elderly patients. Is it related to quality of life?

Objective

The aim of this study is to assess the quality of life in chronically-ill elderly patients and its relationship with parameters concerning the patients’ nutritional status.

Design

A cross-sectional study.

Setting

Primary health-care centres in Jaen, Spain.

Participants

A total of 168 chronically-ill elderly outpatients aged from 65 to 89 years.

Measurements

Quality of life was measured using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire. A nutritional assessment was undertaken including socio-demographic variables, anthropometric measurements (body-mass index and calf circumference), functional evaluation (Barthel index and Folstein mini-mental status test) and a dietetic questionnaire. The mini-nutritional assessment test was used as an assessment tool to detect nutritional risk.

Results

Quality of life in chronically-ill elderly subjects, as determined by the WHOQOL-BREF questionnaire, which diminishes with age, is independent of anthropometric parameters and a statistically significant difference was found between gender, socio-demographic characteristics, functional capacity, nutritional status and the kind of chronic disease (p<0.05).

Conclusion

The relationship between the quality of life with the patients’ socio-demographic characteristics, functional capacity and nutritional status underlines the importance of taking these factors into account in the management of chronically ill patients, especially women.     

Neuroimaging outcomes in clinical trials in Alzheimer’s disease

The first disease modifying drugs targeting beta amyloid that were tested in phase II and III clinical trials have been disappointing. We believe that failures descended from a leaky drug development pipeline where insufficient attention has been devoted to valid animal models and valid imaging markers of disease progression. In the future, valid animal models will need to take into greater consideration the natural and molecular history of AD, where both beta amyloid and tau play a key role. Valid imaging markers of disease progression will need to be identified in humans and translated into animal versions. Future testing of putative disease modifying drugs in valid animal models with valid imaging markers of disease progression will allow to maximize the predictability of their effect in phase II and III clinical trials.     

Direct costs of Alzheimer’s disease in Germany

Objectives  

The aim of this analysis was to determine the direct costs for patients with Alzheimer’s disease (AD) based on data supplied by a large German statutory health insurance (BARMER). Focus of the present evaluation is the exposure of total direct costs, survival rates and the types of care distribution of patients with AD.