Skip to main content
SpringerLink
Log in

An open-ended question: Alzheimer’s disease and involuntary weight loss: which comes first?

  • Mini Review
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background and aims: After the onset of Alzheimer’s disease (AD), a substantial percentage of patients experience involuntary weight loss (IWL), but there is some debate as to whether IWL is a cause or a consequence of AD. It may play a causal role, because nutritional deficiencies have been found to be associated with worsened cognitive performance, even in subjects without dementia. Conversely, it may be an effect of the disease, considering the hypothesis that the neurodegenerative process associated with AD may itself lead to IWL. The aim of the present review was to help to shed some light on the relationship between IWL and AD. Methods: We focus on the problem of the relationship between AD and IWL, and on which comes first. Results: Even when external factors are well controlled, the association between IWL and the progression of AD seems, for the time being, to be unavoidable. Conclusion: In the light of the literature on the topic, we conclude that IWL is more a consequence than a cause of AD, although chronic diseases and disabilities are factors that may facilitate cognitive decline and accelerate the onset of AD if they are not adequately treated from the nutritional standpoint.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wallace JI, Schwart RS. Involuntary weight loss in elderly out-patients: recognition, etiologies, and treatment. Clin Geriatr Med 1997; 13: 717–35.

    CAS  PubMed  Google Scholar 

  2. Vanderschueren S, Geens E, Knockaert D, Bobbaers H. The diagnostic spectrum of unintentional weight loss. Eur J Int Med 2005; 16: 160–4.

    Article  Google Scholar 

  3. Inelmen EM, Sergi G. Biochemical parameters of nutrition. In Mantovani G, ed. Cachexia and wasting. A modern approach. Springer-Verlag, Italia, 2006: 59–72.

    Chapter  Google Scholar 

  4. Andrieu S, Reynish W, Nourhashemi F et al. Nutritional risk factors for institutional placement in Alzheimer’s disease after one year follow-up. J Nutr Health Aging 2001; 5: 113–7.

    CAS  PubMed  Google Scholar 

  5. Morgan DB, Hullin RP. The body composition of the chronic mentally ill. J Clin Nutr 1982; 36C: 439–48.

    Google Scholar 

  6. Singh S, Mulley GP, Losowsky MS. Why are Alzheimer’s patients thin? Age Ageing 1988; 17: 21–8.

    Article  CAS  PubMed  Google Scholar 

  7. Nourhashemi F, Deschamps V, Larrieu S, Letenneur L, Dartigues JF, Barberger-Gateau P; PAQUID study. Personnes Agées Quid. Body mass index and incidence of dementia: the PAQUID study. Neurology 2003; 60: 117–9.

    Article  CAS  PubMed  Google Scholar 

  8. Gillette Guyonnet S, Abellan Van Kan G, Alix E et al. IANA (International Academy on Nutrition and Aging) Expert Group: weight loss and Alzheimer’s disease. J Nutr Health Aging 2007; 11: 38–48.

    CAS  PubMed  Google Scholar 

  9. Grundman M, Corey-Bloom J, Jernigan T, Archibald S, Than LJ. Low body weight in Alzheimer disease is associated with mesial temporal cortex atrophy. Neurology 1996; 46: 1585–91.

    Article  CAS  PubMed  Google Scholar 

  10. Hu X, Okamura N, Arai H, et al. Neuroanatomical correlates of low body weight in Alzheimer’s disease: a PET study. Prog Neuropsychopharmacol Biol Psychiatry 2002; 26: 1285–9.

    Article  PubMed  Google Scholar 

  11. Devinsky O, Morrel MJ, Vogt BA. Contributions of anterior cingulated cortex to behaviour. Brain 1995; 118: 279–306.

    Article  PubMed  Google Scholar 

  12. Tataranni PA, Gautier J-F, Chen K et al. Neuroanatomical correlates of hunger and satiation in humans using positron emission tomography. Proc Natl Acad Sci USA 1999; 96: 4569–74.

    Article  CAS  PubMed  Google Scholar 

  13. Qureshy A, Kawashima R, Imran MB et al. Functional mapping of human brain in olfactory processing: a PET study. J Neurophysiol 2000; 84: 1656–66.

    CAS  PubMed  Google Scholar 

  14. Hamdy S, Mikulis DJ, Crawley A et al. Cortical activation during human volitional swallowing: an event-related fMRI study. Am J Physiol 1999; 277: G219–25.

    CAS  PubMed  Google Scholar 

  15. Kinomura S, Kawashima R, Yamada K et al. Functional anatomy of taste perception in the human brain studied with positron emission tomography. Brain Res 1994; 659: 263–6.

    Article  CAS  PubMed  Google Scholar 

  16. Scheff SW, Sparks L, Price DA. Quantitative assessment of synaptic density in the entorhinal cortex in Alzheimer’s disease. Ann Neurol 1993; 34: 356–61.

    Article  CAS  PubMed  Google Scholar 

  17. Rasmuson S, Nasman B, Carlstrom K, Olsson T. Increased levels of adrenocortical and gonadal hormones in mild to moderate Alzheimer’s disease. Dement Geriatr Cogn Disord 2002; 13: 74–9.

    Article  CAS  PubMed  Google Scholar 

  18. Ogawa M, Fukuyama H, Ouchi Y, Yamauchi H, Kimura J. Altered energy metabolism in Alzheimer’s disease. J Neurol Sci 1996; 139: 78–82.

    Article  CAS  PubMed  Google Scholar 

  19. Sergi G, Coin A, Marin S et al. Body composition and resting energy expenditure in elderly male patients with chronic obstructive pulmonary disease. Respir Med 2006; 100: 1918–24.

    Article  PubMed  Google Scholar 

  20. Sergi G, Coin A, Mulone S et al. Resting energy expenditure and body composition in bedridden institutionalized elderly women with advanced-stage pressure sores. J Gerontol A Biol Sci Med Sci 2007; 62: 317–22.

    Article  PubMed  Google Scholar 

  21. Wolf-Klein GP, Silverstone FA, Lansey SC et al. Energy requirements in Alzheimer’s disease patients. Nutrition 1995; 11: 264–8.

    CAS  PubMed  Google Scholar 

  22. Niskanen L, Piirainen M, Koljonen M, Uusitupa M. Resting energy expenditure in relation to energy intake in patients with Alzheimer’s disease, multi-infarct dementia and in control women. Age Ageing 1993; 22: 132–7.

    Article  CAS  PubMed  Google Scholar 

  23. Sandman PO, Adolfsson R, Nygren C, Hallmans G, Winblad B. Nutritional status and dietary intake in institutionalized patients with Alzheimer’s disease and multi-infarct dementia. J Am Geriatr Soc 1987; 35: 31–8.

    CAS  PubMed  Google Scholar 

  24. Poehlman ET, Gardner AW, Goran MI. Influence of endurance training on energy intake, norepinephrine kinetics, and metabolic rate in older individuals. Metabolism 1992; 41: 941–8.

    Article  CAS  PubMed  Google Scholar 

  25. Prentice AM, Leavesley K, Murgatroyd PR et al. Is severe wasting in elderly mental patients caused by an excessive energy requirement? Age Ageing 1989; 18: 158–67.

    Article  CAS  PubMed  Google Scholar 

  26. Gillette-Guyonnet S, Nourhashémi F, Andrieu S et al. Weight loss in Alzheimer’s disease. Am J Clin Nutr 2000; 71: 650S–5S.

    Google Scholar 

  27. Guyonnet S, Nourhashémi F, Andrieu S et al. A prospective study in the nutritional status of Alzheimer’s patients. Arch Gerontol Geriatr 1998; (Suppl): 255–62.

  28. Barrett-Connor E, Edelstein SL, Corey-Bloom J, Wiederholt WC. Weight loss precedes dementia in community-dwelling older adults. J Am Geriatr Soc 1996; 44: 1147–52.

    CAS  PubMed  Google Scholar 

  29. Wang SY, Fikagawa N, Hossain M, Ooi WL. Longitudinal weight changes, length of survival, and energy requirements of long-term care residents with dementia. J Am Geriatr Soc 1997; 45: 1189–95.

    CAS  PubMed  Google Scholar 

  30. Stewart R, Masaki K, Xue QL et al. A 32-year prospective study of change in body weight and incident dementia: the Honolulu- Asia Aging Study. Arch Neurol 2005; 62: 55–60.

    Article  PubMed  Google Scholar 

  31. Elmståhl S, Steen B. Hospital nutrition in geriatric long-term care medicine: II Effects of dietary supplements. Age Ageing 1987; 16: 73–80.

    Article  PubMed  Google Scholar 

  32. Buchman AS, Wilson RS, Bienias JL, Shah RC, Evans DA, Bennett DA. Change in body mass index and risk of incident Alzheimer disease. Neurology 2005; 65: 892–7.

    Article  CAS  PubMed  Google Scholar 

  33. Yen PK. Weight loss resulting from Alzheimer’s disease. Geriatr Nurs 1997; 18: 132–3.

    Article  CAS  PubMed  Google Scholar 

  34. Milne AC, Potter J, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev 2002; 3: CD003288.

    Google Scholar 

  35. Schulz R, O’Brien AT, Bookwala J, Fleissner K. Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. Gerontologist 1995; 35: 771–91.

    Article  CAS  PubMed  Google Scholar 

  36. Vitaliano PP, Young HM, Russo J, Romano J, Magana-Amato A. Does expressed emotion in spouses predict subsequent problems among care recipients with Alzheimer’s disease? J Geriatr 1993; 48: P202–9.

    CAS  Google Scholar 

  37. Dunkin JJ, Anderson-Hanley C. Dementia caregiver burden. A review of the literature and guidelines for assessment and intervention. Neurology 1998; 51 (Suppl): S53–60.

    Article  CAS  PubMed  Google Scholar 

  38. Fredman L, Daly MP. Weight change: a measure of caregiver stress. J Aging Health 1997; 9: 43–9.

    Article  CAS  PubMed  Google Scholar 

  39. Rivière S, Gillette-Guyonnet S, Voisin T et al. A nutritional education program could prevent weight loss and slow cognitive decline in Alzheimer’s disease. J Nutr Health Aging 2001; 5: 295–9.

    PubMed  Google Scholar 

  40. Volkert D, Berner YN, Berry E et al; DGEM (German Society for Nutritional Medicine), Lenzen-Grossimlinghaus R, Krys U, Pirlich M et al; ESPEN (European Society for Parenteral and Enterai Nutrition). ESPEN Guidelines on Enterai Nutrition. Geriatr Clin Nutr 2006; 25: 330–60.

    Article  CAS  Google Scholar 

  41. Avenell A, Handoll HH. Nutritional supplementation for hip fracture aftercare in the elderly. Cochrane Database Syst Rev 2004; (1): CD001880.

  42. Lauque S, Arnaud-Battandier F, Mansourian R et al. Protein-energy oral supplementation in malnourished nursing-home residents. A controlled trial. Age Ageing 2000; 29: 51–6.

    CAS  Google Scholar 

  43. Gazzotti C, Arnaud-Battandier F, Parello M et al. Prevention of malnutrition in older people during and after hospitalisation: results from a randomised controlled clinical trial. Age Ageing 2003; 32: 321–5.

    Article  PubMed  Google Scholar 

  44. Lauque S, Arnaud-Battandier F, Gillette S et al. Improvement of weight and fat-free mass with oral nutritional supplementation in patients with Alzheimer’s disease at risk of malnutrition: a prospective randomized study. J Am Geriatr Soc 2004; 52: 1702–7.

    Article  PubMed  Google Scholar 

  45. Milne AC, Potter J, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev 2005; Issue 1. Art. No.: CD003288.pub2. DOI: 10.1002/14651858.

  46. Gray-Donald K, Payette H, Boutier V. Randomized clinical trial of nutritional supplementation shows little effect on functional status among free-living frail elderly. J Nutr 1995; 125: 2965–71.

    CAS  PubMed  Google Scholar 

  47. Stableforth PG. Supplement feeds and nitrogen and calorie balance following femoral neck fracture. Br J Surg 1986; 73:651–5.

    Article  CAS  PubMed  Google Scholar 

  48. Miller MD, Daniels LA, Bannerman E, Crotty M. Adherence to nutrition supplements among patients with a fall-related lower limb fracture. Nutr Clin Pract 2005; 20: 569–78.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medical and Surgical Sciences,Geriatrics Section, University of Padova, Italy

    Emine M. Inelmen MD, Giuseppe Sergi, Alessandra Coin, Agostino Girardi & Enzo Manzato

Authors
  1. Emine M. Inelmen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuseppe Sergi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandra Coin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Agostino Girardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Enzo Manzato
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emine M. Inelmen MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Inelmen, E.M., Sergi, G., Coin, A. et al. An open-ended question: Alzheimer’s disease and involuntary weight loss: which comes first?. Aging Clin Exp Res 22, 192–197 (2010). https://doi.org/10.1007/BF03324796

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03324796

Keywords

Search

Navigation