title: Motor, psychiatric and fatigue features associated with nutritional status and its effects on quality of life in Parkinson's disease patients.
abstract: OBJECTIVE
  Parkinson's disease (PD) patients are more likely to develop impaired nutritional status because of the symptoms, medications and complications of the disease. However, little is known about the determinants and consequences of malnutrition in PD. This study aimed to investigate the association of motor, psychiatric and fatigue features with nutritional status as well as the effects of malnutrition on different aspects of quality of life (QoL) in PD patients.
  
  
  METHODS
  One hundred and fifty patients with idiopathic PD (IPD) were recruited in this study. A demographic checklist, the Unified Parkinson's Disease Rating Scale (UPDRS), the Hospital Anxiety and Depression Scale (HADS) and the Fatigue Severity Scale (FSS) were completed through face-to-face interviews and clinical examinations. The health-related QoL (HRQoL) was also evaluated by means of the Parkinson's Disease Questionnaire (PDQ-39). For evaluation of nutritional status, the Mini Nutritional Assessment (MNA) questionnaire was applied together with anthropometric measurements.
  
  
  RESULTS
  Thirty seven (25.3%) patients were at risk of malnutrition and another 3 (2.1%) were malnourished. The total score of the UPDRS scale (r =  -0.613, P<0.001) and PD duration (r =  -0.284, P = 0.002) had a significant inverse correlation with the total MNA score. The median score of the Hoehn and Yahr stage was significantly higher in PD patients with abnormal nutritional status [2.5 vs. 2.0; P<0.001]. More severe anxiety [8.8 vs. 5.9; P = 0.002], depression [9.0 vs. 3.6; P<0.001] and fatigue [5.4 vs. 4.2; P<0.001] were observed in PD patients with abnormal nutritional status. Except for stigma, all other domains of the PDQ-39 were significantly correlated with the total score of the MNA.
  
  
  CONCLUSIONS
  Our study demonstrates that disease duration, severity of motor and psychiatric symptoms (depression, anxiety) and fatigue are associated with nutritional status in PD. Different aspects of the HRQoL were affected by patients' nutritional status especially the emotional well-being and mobility domains.
authors.affiliation: Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Firoozgar Clinical Research Development Center (FCRDC), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed-Mohammad
authors.initials: SM
authors.lastname: Fereshtehnejad
authors.affiliation: Department of Biosciences and Nutrition, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ladan
authors.initials: L
authors.lastname: Ghazi
authors.affiliation: Medical Students Research Committee (MSRC), Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mahdiyeh
authors.initials: M
authors.lastname: Shafieesabet
authors.affiliation: Movement Disorders Clinic, Department of Neurology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Gholam Ali
authors.initials: GA
authors.lastname: Shahidi
authors.affiliation: Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Aging Research Center, Sabzevar University of Medical Sciences, Sabzevar, Khorasan, Iran.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Delbari
authors.affiliation: Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Lökk
mesh_terms: D001007:Anxiety / Q000150:complications / Q000523:psychology; D003863:Depression / Q000150:complications / Q000523:psychology; D005221:Fatigue / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D010300:Parkinson Disease / Q000150:complications / Q000503:physiopathology* / Q000523:psychology*; D011788:Quality of Life; D012044:Regression Analysis