Markers of Disease Severity Are Associated with Malnutrition in Parkinson's Disease

Jamie M Sheard,George D Mellick,Peter A Silburn,Susan Ash,Graham K Kerr,Mathias Toft

doi:10.1371/journal.pone.0057986

Abstract

ObjectiveIn Parkinson's disease (PD), commonly reported risk factors for malnutrition in other populations commonly occur. Few studies have explored which of these factors are of particular importance in malnutrition in PD. The aim was to identify the determinants of nutritional status in people with Parkinson's disease (PWP).MethodsCommunity-dwelling PWP (>18 years) were recruited (n = 125; 73M/52F; Mdn 70 years). Self-report assessments included Beck's Depression Inventory (BDI), Spielberger Trait Anxiety Inventory (STAI), Scales for Outcomes in Parkinson's disease – Autonomic (SCOPA-AUT), Modified Constipation Assessment Scale (MCAS) and Freezing of Gait Questionnaire (FOG-Q). Information about age, PD duration, medications, co-morbid conditions and living situation was obtained. Addenbrooke's Cognitive Examination (ACE-R), Unified Parkinson's Disease Rating Scale (UPDRS) II and UPDRS III were performed. Nutritional status was assessed using the Subjective Global Assessment (SGA) as part of the scored Patient-Generated Subjective Global Assessment (PG-SGA).ResultsNineteen (15%) were malnourished (SGA-B). Median PG-SGA score was 3. More of the malnourished were elderly (84% vs. 71%) and had more severe disease (H&Y: 21% vs. 5%). UPDRS II and UPDRS III scores and levodopa equivalent daily dose (LEDD)/body weight(mg/kg) were significantly higher in the malnourished (Mdn 18 vs. 15; 20 vs. 15; 10.1 vs. 7.6 respectively). Regression analyses revealed older age at diagnosis, higher LEDD/body weight (mg/kg), greater UPDRS III score, lower STAI score and higher BDI score as significant predictors of malnutrition (SGA-B). Living alone and higher BDI and UPDRS III scores were significant predictors of a higher log-adjusted PG-SGA score.ConclusionsIn this sample of PWP, the rate of malnutrition was higher than that previously reported in the general community. Nutrition screening should occur regularly in those with more severe disease and depression. Community support should be provided to PWP living alone. Dopaminergic medication should be reviewed with body weight changes.

Highlights

While limited research has been conducted to determine the predictors of malnutrition in Parkinson’s disease (PD), it has been reported that depression and constipation are significant predictors of malnutrition [14]
Factors that are specific to PD that may place someone at nutritional risk include the motor symptoms of bradykinesia, akinesia, rigidity, and tremor which can impair functional ability and make it difficult to ambulate [15], shop, cook, and feed independently [16,17]
One participant did not complete any of the self-administered questionnaires (BDI, Spielberger Trait Anxiety Inventory (STAI), SCOPA-AUT, Modified Constipation Assessment Scale (MCAS), Freezing of Gait Questionnaire (FOG-Q))

Summary

Introduction

Well-documented risk factors for poor nutrition in communitydwelling adults include older age [1,2], living alone [3], dementia [4,5], depression [1,3,5], anorexia [6], gastrointestinal dysfunction (dysphagia, slow gastric emptying, constipation) [7,8], poor functional status [3,5], co-morbidities [9] and polypharmacy [3].In Parkinson’s disease (PD), these risk factors are common, often occurring more frequently than in age-matched controls, including dementia [10], depression [11] and gastrointestinal disorders (dysphagia [12,13], early satiety [12] and constipation [13]). Well-documented risk factors for poor nutrition in communitydwelling adults include older age [1,2], living alone [3], dementia [4,5], depression [1,3,5], anorexia [6], gastrointestinal dysfunction (dysphagia, slow gastric emptying, constipation) [7,8], poor functional status [3,5], co-morbidities [9] and polypharmacy [3]. It has been reported that disease severity (Hoehn & Yahr) is associated with decreased body mass indices (BMI) [18], but Hoehn & Yahr classification does not significantly predict a diagnosis of malnutrition using the MiniNutritional Assessment (MNA) [14]

Methods

Results

Conclusion