Abstract
Objective:To compare weight change over time in patients with Parkinson disease (PD), those with atypical parkinsonism, and matched controls; to identify baseline factors that influence weight loss in parkinsonism; and to examine whether it predicts poor outcome.Methods:We analyzed data from the Parkinsonism Incidence in North-East Scotland (PINE) study, an incident, population-based prospective cohort of parkinsonian patients and age- and sex-matched controls with annual follow-up. Mixed-model analysis described weight change in patients with PD, those with atypical parkinsonism, and controls. Baseline determinants of sustained clinically significant weight loss (>5% loss from baseline) and associations between early sustained weight loss and death, dementia, and dependency in parkinsonism were studied with Cox regression.Results:A total of 515 participants (240 controls, 187 with PD, 88 with atypical parkinsonism) were followed up for a median of 5 years. At diagnosis, atypical parkinsonian patients had lower body weights than patients with PD, who were lighter than controls. Patients with PD lost weight more rapidly than controls, and weight loss was most rapid in atypical parkinsonism. After multivariable adjustment for potential confounders, only age was independently associated with sustained clinically significant weight loss (hazard ratio [HR] for 10-year age increase 1.83, 95% confidence interval [CI] 1.44–2.32). Weight loss occurring within 1 year of diagnosis was independently associated with increased risk of dependency (HR 2.11, 95% CI 1.00–4.42), dementia (HR 3.23, 95% CI 1.40–7.44), and death (HR 2.23, 95% CI 1.46–3.41).Conclusion:Weight loss occurs in early parkinsonism and is greater in atypical parkinsonism than in PD. Early weight loss in parkinsonism has prognostic significance, and targeted dietary interventions to prevent it may improve long-term outcomes.
Highlights
Weight loss occurs in early parkinsonism and is greater in atypical parkinsonism than in Parkinson disease (PD)
Previous studies have shown that weight loss is common in Parkinson disease (PD),[1,2] is not explained solely by reduced nutritional intake or increased energy expenditure,[3] and may be associated with worse outcomes.[4,5,6,7,8,9]
2 studies have compared the degree of weight loss and its early risk factors in PD,[5,10] but none has compared PD with other atypical parkinsonian syndromes, compared patients with PD with controls over long-term follow-up from diagnosis in an unselected incident cohort of patients, or assessed the effect of early weight loss on long-term outcomes
Summary
We analyzed data from the Parkinsonism Incidence in North-East Scotland (PINE) study, an incident, population-based prospective cohort of parkinsonian patients and age- and sexmatched controls with annual follow-up. Mixed-model analysis described weight change in patients with PD, those with atypical parkinsonism, and controls. The Parkinsonism Incidence in North-East Scotland (PINE) study is a population-based incident cohort of parkinsonism with annual prospective lifelong followup.[11,12] The study design and recruitment methods were previously described.[11,12] In brief, multiple ascertainment strategies were used to identify all new diagnoses of degenerative or vascular parkinsonism occurring in a population of z300,000 during 2 incidence periods, 2002 to 2004 and 2006 to 2009. Patients and controls had annual assessment including clinical history and examination, review of medical case notes, and various assessment scales. Body weight was measured annually with regularly calibrated hospital scales
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