A 6-month observational study of the relationship between weight loss and behavioral symptoms in institutionalized Alzheimer's disease subjects.
OBJECTIVE
Weight loss is a common occurrence in Alzheimer's disease (AD). This study was undertaken to investigate the relationship between weight loss and behavioral symptoms in institutionalized AD subjects.


METHODS
Observational study.


METHODS
Two facilities that included assisted living and nursing care.


METHODS
Residents with probable or possible AD (n = 32).


METHODS
Weight was measured monthly. At baseline, month 3, and month 6, a knowledgeable staff member provided information that included the Neuropsychiatric Inventory: Nursing Home Version (NPI-NH, ie, a measure of behavioral symptoms) and a questionnaire regarding eating habits, food intake, and appetite. Two-day calorie counts were done and accelerometers were worn to monitor physical activity.


RESULTS
At baseline, the mean body mass index (BMI) was 24.0 (standard deviation, 3.5) with 12 subjects exhibiting a BMI <22. BMI was negatively associated with the baseline NPI-NH total score (Spearman Correlation Coefficient -0.52, P <0.01), which indicates that subjects with low BMIs were more likely to have higher frequency and severity of behavioral problems. Individual behavior scores for agitation/aggression (-0.40, P <0.05), depression (-0.31, P = 0.08), irritability/lability (-0.47, P <0.01), aberrant motor behavior (ie, pacing, -0.42, P <0.05), nighttime behavior (-0.37, P = 0.05), and appetite/eating (-0.48, P <0.01) at baseline were negatively correlated with baseline BMI. Behaviors not correlated with BMI were delusions, hallucinations, elation, apathy, and disinhibition. Although this was a small sample followed for a relatively short time period, change in specific NPI-NH scores from baseline to month 6 were correlated with the change in weight over the 6-month period. Both agitation/aggression (-0.37, P = 0.05) and disinhibition (-0.45, P <0.05) showed negative correlation with weight change, which indicates an association between changes in these behaviors and weight loss. There were no significant differences between those who lost weight (n = 13) and those who did not (n = 19) on baseline variables, which included age, comorbidity, functional status, and NPI-NH. However, those who lost weight had a significantly higher BMI at baseline than those who gained weight.


CONCLUSIONS
These preliminary results suggest that behavioral disturbances play a role in low body weight and weight loss in AD subjects.
Center for the Study of Aging and Human Development, Department of Medicine, Duke University Medical Center, Durham, NC, USA. white031@mc.duke.edu
Heidi K
HK
White
Eleanor S
ES
McConnell
Connie W
CW
Bales
Maragatha
M
Kuchibhatla
D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000503:physiopathology*; D040561:Assisted Living Facilities; D001526:Behavioral Symptoms / Q000503:physiopathology*; D015992:Body Mass Index; D002149:Energy Intake / Q000502:physiology; D005247:Feeding Behavior; D005260:Female; D006306:Health Surveys; D006801:Humans; D007326:Institutionalization; D008297:Male; D009043:Motor Activity / Q000502:physiology; D009657:North Carolina; D019370:Observation; D012866:Skilled Nursing Facilities; D015431:Weight Loss / Q000502:physiology*