Journal of Neurology

, Volume 264, Issue 8, pp 1746–1753 | Cite as

Predictors of weight loss in early treated Parkinson’s disease from the NET-PD LS-1 cohort

  • Anne-Marie Wills
  • Ruosha Li
  • Adriana Pérez
  • Xuehan Ren
  • James Boyd
  • on behalf of the NINDS NET-PD Investigators
Original Communication

Abstract

Weight loss is a common symptom of Parkinson’s disease and is associated with impaired quality of life. Predictors of weight loss have not been studied in large clinical cohorts. We previously observed an association between change in body mass index and change in Unified Parkinson’s Disease Rating Scale (UPDRS) motor and total scores. In this study, we performed a secondary analysis of longitudinal data (1–6 years) from 1619 participants in the NINDS Exploratory Trials in PD Long-term Study-1 (NET-PD LS1) to explore predictors of weight loss in a large prospective clinical trial cohort of early treated Parkinson’s disease. The NET-PD LS1 study was a double-blind randomized placebo controlled clinical trial of creatine monohydrate 10 gm/day in early treated PD (within 5 years of diagnosis and within 2 years of starting dopaminergic medications). Linear mixed models were used to estimate the effect of baseline clinical covariates on weight change over time. On average, participants lost only 0.6 kg per year. Higher age, baseline weight, female gender, higher baseline UPDRS scores, greater postural instability, difficulty eating and drinking, lower cognitive scores and baseline levodopa use (compared to dopamine agonists) were all associated with weight loss. Surprisingly baseline difficulty swallowing, dyskinesia, depression, intestinal hypomotility (constipation) and self-reported nausea/vomiting/anorexia were not significantly associated with weight loss in this cohort of early treated Parkinson’s disease patients. On average, participants with Parkinson’s disease experience little weight loss during the first 1–6 years after starting dopaminergic replacement therapy, however levodopa use and postural instability were both predictors of early weight loss.

Trial Registration clinicaltrials.gov identifier# NCT00449865.

Keywords

BMI Weight loss Dysphagia Nausea Parkinson’s disease 

References

  1. 1.
    Akbar U, He Y, Dai Y, Hack N, Malaty I, McFarland NR et al (2015) Weight loss and impact on quality of life in Parkinson’s disease. PLoS One 10(5):e0124541CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Wills AM, Perez A, Wang J, Su X, Morgan J, Rajan SS et al (2016) Association between change in body mass index, unified Parkinson’s disease rating scale scores, and survival among persons with Parkinson disease: secondary analysis of longitudinal data from NINDS Exploratory Trials in Parkinson Disease Long-term Study 1. JAMA Neurol 73(3):321–328CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Bachmann CG, Trenkwalder C (2006) Body weight in patients with Parkinson’s disease. Mov Disord 21(11):1824–1830CrossRefPubMedGoogle Scholar
  4. 4.
    Markus HS, Tomkins AM, Stern GM (1993) Increased prevalence of undernutrition in Parkinson’s disease and its relationship to clinical disease parameters. J Neural Transm Parkinson’s Dis Dement Sect 5(2):117–125CrossRefGoogle Scholar
  5. 5.
    Sheard JM, Ash S, Mellick GD, Silburn PA, Kerr GK (2013) Markers of disease severity are associated with malnutrition in Parkinson’s disease. PLoS One 8(3):e57986CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Uc EY, Struck LK, Rodnitzky RL, Zimmerman B, Dobson J, Evans WJ (2006) Predictors of weight loss in Parkinson’s disease. Mov Disord 21(7):930–936CrossRefPubMedGoogle Scholar
  7. 7.
    Elm JJ (2012) Design innovations and baseline findings in a long-term Parkinson’s trial: the National Institute of Neurological Disorders and Stroke Exploratory Trials in Parkinson’s Disease Long-term Study-1. Mov Disord 27(12):1513–1521CrossRefPubMedGoogle Scholar
  8. 8.
    Kieburtz K, Tilley BC, Elm JJ, Babcock D, Hauser R, Ross GW et al (2015) Effect of creatine monohydrate on clinical progression in patients with Parkinson disease: a randomized clinical trial. JAMA 313(6):584–593CrossRefPubMedGoogle Scholar
  9. 9.
    Pérez A, Tilley BC (2015) Conduct of stroke-related clinical trials. In: Grotta et al (eds) Stroke: Pathophysiology, diagnosis, and management, 6th edn, Elsevier Google Scholar
  10. 10.
    Gaddey HL, Holder K (2014) Unintentional weight loss in older adults. Am Fam Phys 89(9):718–722Google Scholar
  11. 11.
    Evans A, Gupta R (2017) Approach to the patient with unintentional weight loss. https://www.uptodate.com/contents/approach-to-the-patient-with-unintentional-weight-loss?source=related_link. Accessed 6 July 2017
  12. 12.
    Chen H, Zhang SM, Hernan MA, Willett WC, Ascherio A (2003) Weight loss in Parkinson’s disease. Ann Neurol 53(5):676–679CrossRefPubMedGoogle Scholar
  13. 13.
    Vikdahl M, Carlsson M, Linder J, Forsgren L, Haglin L (2014) Weight gain and increased central obesity in the early phase of Parkinson’s disease. Clin Nutr 33(6):1132–1139CrossRefPubMedGoogle Scholar
  14. 14.
    Barichella M, Cereda E, Madio C, Iorio L, Pusani C, Cancello R et al (2013) Nutritional risk and gastrointestinal dysautonomia symptoms in Parkinson’s disease outpatients hospitalised on a scheduled basis. Br J Nutr 110(2):347–353CrossRefPubMedGoogle Scholar
  15. 15.
    Toth MJ, Fishman PS, Poehlman ET (1997) Free-living daily energy expenditure in patients with Parkinson’s disease. Neurology 48(1):88–91CrossRefPubMedGoogle Scholar
  16. 16.
    Macia F, Perlemoine C, Coman I, Guehl D, Burbaud P, Cuny E et al (2004) Parkinson’s disease patients with bilateral subthalamic deep brain stimulation gain weight. Mov Disord 19(2):206–212CrossRefPubMedGoogle Scholar
  17. 17.
    Bachmann CG, Zapf A, Brunner E, Trenkwalder C (2009) Dopaminergic treatment is associated with decreased body weight in patients with Parkinson’s disease and dyskinesias. Eur J Neurol 16(8):895–901CrossRefPubMedGoogle Scholar
  18. 18.
    Sharma JC, Turton J (2012) Olfaction, dyskinesia and profile of weight change in Parkinson’s disease: identifying neurodegenerative phenotypes. Parkinsonism Relat Disord 18(8):964–970CrossRefPubMedGoogle Scholar
  19. 19.
    Tsuge A, Kaneko S, Wate R, Oki M, Nagashima M, Asayama S et al (2017) Weight loss in the early stage of progressive supranuclear palsy. Brain behav 7(2):e00616CrossRefPubMedGoogle Scholar
  20. 20.
    Park H, Lee JY, Shin CM, Kim JM, Kim TJ, Kim JW (2015) Characterization of gastrointestinal disorders in patients with parkinsonian syndromes. Parkinsonism Relat Disord 21(5):455–460CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Anne-Marie Wills
    • 1
  • Ruosha Li
    • 2
  • Adriana Pérez
    • 3
  • Xuehan Ren
    • 2
  • James Boyd
    • 4
  • on behalf of the NINDS NET-PD Investigators
  1. 1.Department of NeurologyMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of BiostatisticsUniversity of Texas Health Science Center at HoustonHoustonUSA
  3. 3.Department of Biostatistics, UTHealthThe University of Texas School of Public HealthAustinUSA
  4. 4.Larner College of MedicineUniversity of Vermont Medical CenterBurlingtonUSA

Personalised recommendations