Prognostic Significance of Weight Loss in Patients With Early Parkinsonism

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Patients who were diagnosed with PD and atypical parkinsonian weighed less than the control group by, 5.6 and 7.1kg respectively.
Patients who were diagnosed with PD and atypical parkinsonian weighed less than the control group by, 5.6 and 7.1kg respectively.

The occurrence of early weight loss in patients with parkinsonism has prognostic significance. However, the use of targeted dietary interventions as a strategy to prevent weight loss is showing promise with respect to improving long-term outcomes, according to the results of a recent incident, population-based, prospective cohort study from Scotland published in Neurology.

The objectives of the study were (1) to compare weight change over time in patients with Parkinson disease (PD), those with atypical parkinsonism, and age- and gender-matched controls; (2) to identify baseline factors that affect weight loss in parkinsonism; and (3) to investigate whether weight loss in this patient population is predictive of poor outcomes.

The researchers analyzed data from the Parkinsonism Incidence in North-East Scotland study. Mixed-model analysis described weight change in patients with PD, those with atypical parkinsonism, and controls. Multivariable Cox regression models were used to evaluate baseline determinants of clinically significant weight loss (ie, >5% loss from baseline), as well as associations between early sustained weight loss and death, dementia, and dependency.

A total of 515 individuals (controls: n=240; PD group: n=187; atypical parkinsonism group: n=88) were enrolled in the study and followed for a median of 5 years. At diagnosis, participants with atypical parkinsonism had lower body weights than those with PD, and participants with PD weighed less than controls. Although individuals with PD lost weight more rapidly than controls, weight loss was most rapid among those with atypical parkinsonism.

Following multivariable adjustment for possible confounders, age was the only factor independently associated with the development of sustained clinically significant weight loss at any time following diagnosis of atypical parkinsonism (hazard ratio, [HR], 1.83; 95% CI, 1.44-2.32 for each 10-year increase in age; P <.001). Weight loss that occurred within 1 year of diagnosis was independently associated with an increased risk for dependency (HR, 2.11; 95% CI, 1.00-4.42; P =.05), dementia (HR, 3.23; 95% CI, 1.40-7.44; P =.006), and death (HR, 2.23; 95% CI, 1.46-3.41; P <.001).

The researchers concluded that targeted dietary strategies aimed at preventing weight loss in patients with parkinsonism may help to improve long-term outcomes. Additional studies designed to investigate the effect of patient characteristics that develop over time in parkinsonism, including medication data, cumulative disease characteristics, and comorbidities, are warranted.

Reference

Cumming K, Macleod AD, Myint PK, Counsell CE.  Early weight loss in parkinsonism predicts poor outcomes: Evidence from an incident cohort study [published online October 27, 2017]. Neurology.doi:10.1212/WNL.0000000000004691

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