title: Characteristics of Alzheimer's disease patients with a rapid weight loss during a six-year follow-up.
abstract: OBJECTIVE
  Weight loss in Alzheimer's disease (AD) may be either progressive or rapid, with different consequences. The aim of this study was to characterize massive weight loss (>or= 5 kg over 6 months) during a 6.5-year follow-up.
  
  
  METHODS
  395 patients with AD (mean age 75.4 years) were included in a prospective single-centre cohort study (mean follow-up 2.5 years). A standardized gerontologic assessment was performed every six months, including nutritional, neuropsychological, functional, and caregiver burden evaluations, along with recording all intercurrent events before weight loss.
  
  
  RESULTS
  Among the 127 cases of weight loss (in 110 subjects, 27.8% of the population), we identified 60 cases of intercurrent illnesses and 88 cases of behavioral and psychological symptoms of dementia (BPSD) during the six months before weight loss. Three factors were independently associated with rapid weight loss: higher initial weight (HR=1.06, 95% CI [1.02, 1.08]), higher Prognosis Inflammatory and Nutritional Index (HR=2.16, 95% CI [1.26, 3.72]) and a higher Cohen-Mansfield agitation inventory score, reflecting BPSD (HR=1.05, 95% CI [1.01, 1.10]). Cholinesterase inhibitors appeared as protective (HR=0.33, 95% CI [0.15, 0.73]). Rapid weight loss was predictive of death at 6 months (HR=3.01, 95% CI [1.73, 5.22]).
  
  
  CONCLUSIONS
  BPSD play an important role in rapid weight loss and should be managed effectively. Biological assessment of malnutrition may be warranted.
authors.affiliation: INSERM U558, Department of Internal Medicine and Clinical Gerontology, CHU de Toulouse, Université Paul Sabatier, France. olivguerin@hotmail.com
authors.forename: Olivier
authors.initials: O
authors.lastname: Guérin
authors.forename: Sandrine
authors.initials: S
authors.lastname: Andrieu
authors.forename: Stéphane M
authors.initials: SM
authors.lastname: Schneider
authors.forename: Frédéric
authors.initials: F
authors.lastname: Cortes
authors.forename: Christelle
authors.initials: C
authors.lastname: Cantet
authors.forename: Sophie
authors.initials: S
authors.lastname: Gillette-Guyonnet
authors.forename: Bruno
authors.initials: B
authors.lastname: Vellas
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D015596:Nutrition Assessment; D009752:Nutritional Status; D011446:Prospective Studies; D013995:Time; D015431:Weight Loss