title: Weight loss and rapid cognitive decline in community-dwelling patients with Alzheimer's disease.
abstract: Weight loss is a frequent complication of Alzheimer's disease (AD) and a strong predictor of adverse outcomes in patients suffering from this disease. The aim of this study was to determine whether weight loss was a predictor of rapid cognitive decline (RCD) in AD. Four hundred fourteen community-dwelling ambulatory patients with a diagnosis of probable AD and a Mini-Mental State Examination (MMSE) score between 10 and 26 from the REAL.FR (REseau sur la maladie d'ALzheimer FRançais) cohort were studied and followed up during 4 years. Patients were classified in 2 groups according to weight loss defined by a loss of 4% or more during the first year of follow-up. RCD was defined as the loss of 3 points or more in MMSE over 6 months. The incidence of RCD was determined among both groups over the last 3 years of follow-up. MMSE, Katz's Activity of Daily Living scale, Mini-Nutritional Assessment scale, co-morbidities, behavioral and psychological symptoms of dementia, medication, level of education, living arrangement, and caregiver's burden were assessed every 6 months. Eighty-seven patients (21.0%) lost 4% or more of their initial weight during the first year. The incidence of RCD for all patients was 57.6 (95% confidence interval (CI) = 51.6-64.8) per 100 person-year (median follow-up of 15.1 months). In Cox proportional hazards models, after controlling for potential confounders, weight loss was a significant predictor factor of RCD (adjusted hazard ratio (HR) = 1.50, 95% CI = 1.04-2.17). In conclusion, weight loss predicted RCD in this cohort. Whether the prevention of weight loss (by improving nutritional status) impacts cognitive decline remains an open question.
authors: Alzheimer's Disease Research and Clinical Centre, Department of Geriatric Medicine, Gérontopôle, Toulouse University Hospital, Toulouse, France. soto-martin.me@chu-toulouse.fr
authors: Maria E
authors: ME
authors: Soto
authors: Marion
authors: M
authors: Secher
authors: Sophie
authors: S
authors: Gillette-Guyonnet
authors: Gabor
authors: G
authors: Abellan van Kan
authors: Sandrine
authors: S
authors: Andrieu
authors: Fati
authors: F
authors: Nourhashemi
authors: Yves
authors: Y
authors: Rolland
authors: Bruno
authors: B
authors: Vellas
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications* / Q000523:psychology; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D012111:Residence Characteristics; D015431:Weight Loss / Q000502:physiology*