The journal of nutrition, health & aging

, Volume 17, Issue 4, pp 295–299

Malnutrition in community-dwelling adults with dementia (Nutrialz Trial)

Article

Abstract

Objectives

The objective of this study is to assess the nutritional status, measured by the MNA, in community-dwelling elderly individuals with dementia and to identify clinical risk factors for nutritional risk or malnutrition.

Design

Cross-sectional analysis of a cluster randomized clinical trial (Nutrialz).

Setting

Community-dwelling individuals attending dementia clinics.

Participants

940 individuals.

Measurements

The clinical scales assessed were Mini Nutritional Assessment (MNA), Eating Behaviour Scale (EBS), Charlson comorbidity index, Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE), Basic Activities of Daily Living (BADL) score, Instrumental Activities of Daily Living (IADL) score, Neuropsychiatric Inventory Questionnaire (NPI-Q), Cornell depression scale and Zarit Caregiver Burden Interview.

Results

5.2% of participants were classified as being malnourished, 42.6% as being at risk of malnutrition and 52.2% as well nourished. Malnutrition by type of dementia was more frequent in Lewy bodies dementia (18.2%) than in the other types. Worse nutritional status is significantly related to more advanced age and worse cognitive, functional and behavioural profile, as well as increased burden for caregivers. Presence of behavioural symptoms is significantly related to worse nutritional level for all NPI-Q symptoms but depression, exaltation, lack of inhibition and irritability. The items more strongly related to malnutrition are appetite/feeding and hallucinations. Dependence in any basic or instrumental ADL is significantly related to higher risk of malnutrition. Dependence on feeding is a strongly related risk factor, while food preparation is only a moderate one. A logistic regression model to predict at risk/malnutrition kept as significant risk factors EBS (Odds Ratio (OR) 0.84, 95%CI 0.78 to 0.91), Cornell (OR 1.12, 95%CI 1.09 to 1.16), the number of dependent BADL (OR 1.29, 95%CI 1.17 to 1.42), age (OR 1.04, 95%CI 1.02–1.06), MMSE (OR 0.95, 95%CI 0.92 to 0.98) and Charlson (OR 1.18, 95%CI 1.05 to 1.34). A similar model built for prediction of malnutrition retained as significant covariables only EBS, Cornell and the number of dependent BADL.

Conclusion

These results will allow a better understanding of the clinical stage previous to malnutrition. An adequate diagnosis and treatment of identified modifiable factors like functional impairment, eating behaviours and depression could delay or avoid malnutrition.

Key words

Dementia elderly malnutrition MNA 

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References

  1. 1.
    White H, Pieper C, Schmader K, et al. Weight change in Alzheimer’s disease. J Am Geriatr Soc. 1996;44(3):1232–1234.Google Scholar
  2. 2.
    White H, Pieper C, Schmader K. The association of weight change in Alzheimer’s disease with severity of disease and mortality: a longitudinal analysis. J Am Geriatr Soc. 1998;46:1223–1227.PubMedGoogle Scholar
  3. 3.
    Soto ME, Secher M, Gillette-Guyonnet S, Abellan van Kan G, Andrieu S, Nourhashemi F, Rolland Y, Vellas B. Weight loss and rapid cognitive decline in community-dwelling patients with Alzheimer’s disease. J Alzheimers Dis. 2012;28(3):647–654.PubMedGoogle Scholar
  4. 4.
    Gillette Guyonnet S, Abellan Van Kan G, Alix E, Andrieu S, Salva A “IANA Expert Group: Weight loss and Alzheimer’s disease”, a Journal of Nutrition, Health and Aging 2007 Jan-Feb;11(1):38–48Google Scholar
  5. 5.
    White HK, McConnell ES, Bales CW, Kuchibhatla M. A 6-month observational study of the relationship between weight loss and behavioral symptoms in institutionalized Alzheimer’s disease subjects. J Am Med Dir Assoc. 2004 Mar–Apr;5(2):89–97.PubMedCrossRefGoogle Scholar
  6. 6.
    Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999 Feb;15(2):116–122.PubMedCrossRefGoogle Scholar
  7. 7.
    Guigoz Y, Vellas B, Garry PJ. Mini nutritional assessment: A practical assessment tool for grading the nutritional state of elderly patients. Facts, Research in Gerontology, 1994;(Suppl 2):15–59Google Scholar
  8. 8.
    Rubenstein LZ, Harker JO, Salvà A, Vellas B. Nutritional Screening in Geriatric Practice: Developing the Short-Form Mini-Nutritional Assessment (MNA-SF). J Gerontol (MS) 2001;56A(6):356–360.Google Scholar
  9. 9.
    Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony P, Charlton KE, Maggio M, Tsai AC, Grathwohl D, Vellas B, Sieber CC Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status.; MNA-International Group. J Nutr Health Aging. 2009 Nov;13(9):782–788.PubMedCrossRefGoogle Scholar
  10. 10.
    Salvà A, Andrieu S, Fernández E, Schiffrin EJ, Moulin J, Decarli B, Guigoz Y, Vellas B, and the NutriAlz group. Health and Nutritional Promotion Program for Patients with Dementia (NutriAlz Study): Design and Baseline Data. J Nutr Health Aging. 2009;13(6):529–537.PubMedCrossRefGoogle Scholar
  11. 11.
    Salvà A, Andrieu S, Fernandez E, Schiffrin EJ, Moulin J, Decarli B, Rojano-i-Luque X, Guigoz Y, Vellas B; NutriAlz group. Health and nutrition promotion program for patients with dementia (NutriAlz): cluster randomized trial. J Nutr Health Aging. 2011 Dec;15(10):822–830.PubMedCrossRefGoogle Scholar
  12. 12.
    Tully MW, Matrakas KL, Muir J, Musallam K. The Eating Behaviour Scale. A simple method of assessing functional ability in patients with Alzheimer’s disease. J Gerontol Nurs. 1997 Jul;23(7):9–15; quiz 54–5.PubMedGoogle Scholar
  13. 13.
    Tully MW, Lambros Matrakas K, Musallam K. The eating behavior scale: a simple method of assessing functional ability in patients with Alzheimer’s disease. J Nutr Health Aging. 1998;2(2):119–121.PubMedGoogle Scholar
  14. 14.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373–383.PubMedCrossRefGoogle Scholar
  15. 15.
    Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 1993;43:2412–2414PubMedCrossRefGoogle Scholar
  16. 16.
    Folstein MF, Fostein SE, McHugh PR. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psych Res 1975;12(3):189–198.CrossRefGoogle Scholar
  17. 17.
    Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged: the Index of ADL, a standardized measure of biological and psychosocial function. JAMA 1963;185:914–919.PubMedCrossRefGoogle Scholar
  18. 18.
    Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9(3):179–186.PubMedCrossRefGoogle Scholar
  19. 19.
    Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, Lopez OL, DeKosky ST. Validation of the NPI-Q, a Brief Clinical Form of the Neuropsychiatric Inventory. J Neuropsychiatry Clin Neurosci 2000;12(2):233–239.PubMedCrossRefGoogle Scholar
  20. 20.
    Boada M, Cejudo JC, Tarraga L, Lopez OL, Kaufer D. Neuropsychiatric inventory questionnaire (NPI-Q): Spanish validation of an abridged form of the Neuropsychiatric Inventory (NPI). Neurologia 2002;17(6):317–323.PubMedGoogle Scholar
  21. 21.
    Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry, 1988 Feb 1;23(3):271–284.PubMedCrossRefGoogle Scholar
  22. 22.
    Zarit SH, Todd PA, Zarit JM. Subjective burden of husbands and wives as caregivers: a longitudinal study. Gerontologist 1986;26(3):260–266.PubMedCrossRefGoogle Scholar
  23. 23.
    Shinagawa S, Adachi H, Toyota Y, Mori T, Matsumoto I, Fukuhara R, Ikeda M. Characteristics of eating and swallowing problems in patients who have dementia with Lewy bodies. Int Psychogeriatr. 2009 Jun;21(3):520–525. Epub 2009 Mar 4.PubMedCrossRefGoogle Scholar
  24. 24.
    Esquius M, Schwartz S, López Hellín J, Andreu AL, García E. [Anthropometric reference parameters for the aged population]. [Article in Spanish] Med Clin (Barc). 1993 May 8;100(18):692–698.Google Scholar
  25. 25.
    Chang CC, Roberts BL. Feeding difficulty in older adults with dementia. J Clin Nurs. 2008 Sep;17(17):2266–2274.PubMedCrossRefGoogle Scholar
  26. 26.
    Gillette-Guyonnet S, Nourhashemi F, Andrieu S, Cantet C, Micas M, Ousset PJ, Vellas B; REAL. FR Group. The REAL.FR research program on Alzheimer’s disease and its management: methods and preliminary results. J Nutr Health Aging. 2003;7(2):91–96.PubMedGoogle Scholar
  27. 27.
    Nourhashemi F, Amouyal-Barkate K, Gillette-Guyonnet S, Cantet C, Vellas B; REAL. FR Group. Living alone with Alzheimer’s disease: cross-sectional and longitudinal analysis in the REAL.FR Study. J Nutr Health Aging. 2005;9(2):117–120.PubMedGoogle Scholar
  28. 28.
    Andrieu S, Reynish W, Nourhashemi F, Ousset PJ, Grandjean H, Grand A, Albarede JL, Vellas B. Nutritional risk factors for institutional placement in Alzheimer’s disease after one year follow-up. J Nutr Health Aging. 2001;5(2):113–117.PubMedGoogle Scholar
  29. 29.
    Isaia G, Mondino S, Germinara C, Cappa G, Aimonino-Ricauda N, Bo M, Isaia GC, Nobili G, Massaia M. Malnutrition in an elderly demented population living at home. Arch Gerontol Geriatr. 2011 Nov–Dec;53(3):249–251. Epub 2011 Jan 13.PubMedCrossRefGoogle Scholar
  30. 30.
    Spaccavento S, Del Prete M, Craca A, Fiore P. Influence of nutritional status on cognitive, functional and neuropsychiatric deficits in Alzheimer’s disease. Arch Gerontol Geriatr. 2009 May–Jun;48(3):356–360. Epub 2008 Apr 29.PubMedCrossRefGoogle Scholar
  31. 31.
    Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature—What does it tell us? J Nutr Health Aging. 2006 Nov-Dec;10(6):466–485; discussion 485–7.PubMedGoogle Scholar
  32. 32.
    Rivière S, Gillette-Guyonnet S, Voisin T, Reynish E, Andrieu S, Lauque S, Salva A, Frisoni G, Nourhashemi F, Micas M, Vellas B. A nutritional education program could prevent weight loss and slow cognitive decline in Alzheimer’s disease. J Nutr Health Aging. 2001;5(4):295–299.PubMedGoogle Scholar
  33. 33.
    Fallon C, Bruce I, Eustace A, et al. Nutritional status of community dwelling subjects attending a memory clinic. J Nutr Health Aging 2002;6(Supp):21Google Scholar
  34. 34.
    Kaiser MJ, Bauer JM, Rämsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony PS, Charlton KE, Maggio M, Tsai AC, Vellas B, Sieber CC; Mini Nutritional Assessment International Group. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010 Sep;58(9):1734–1738. doi: 10.1111/j.1532-5415.2010.03016.x.PubMedCrossRefGoogle Scholar
  35. 35.
    Nykänen I, Lönnroos E, Kautiainen H, Sulkava R, Hartikainen S. Nutritional screening in a population-based cohort of community-dwelling older people. Eur J Public Health. 2012 Apr 25. [Epub ahead of print]Google Scholar
  36. 36.
    Zekry D, Herrmann FR, Grandjean R, Meynet MP, Michel JP, Gold G, Krause KH. Demented versus non-demented very old inpatients: the same comorbidities but poorer functional and nutritional status. Age Ageing. 2008 Jan;37(1):83–89. Epub 2007 Oct 30.PubMedCrossRefGoogle Scholar
  37. 37.
    Cuervo M, García A, Ansorena D, Sánchez-Villegas A, Martínez-González M, Astiasarán I, Martínez J. Nutritional assessment interpretation on 22,007 Spanish community-dwelling elders through the Mini Nutritional Assessment test. Public Health Nutr. 2009 Jan;12(1):82–90. Epub 2008 Apr 16.PubMedCrossRefGoogle Scholar
  38. 38.
    Guerin O, Soto ME, Brocker P, Robert PH, Benoit M, Vellas B; REAL. FR Group. Nutritional status assessment during Alzheimer’s disease: results after one year (the REAL French Study Group). J Nutr Health Aging. 2005;9(2):81–84.PubMedGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Institut de l’EnvellimentUniversitat Autònoma de Barcelona, Sant Pau Institute of Biomedical Research (IIB-Sant Pau)BarcelonaSpain
  2. 2.Inserm U558University of Toulouse IIIToulouseFrance
  3. 3.GérontopôleHôpitaux de ToulouseToulouseFrance
  4. 4.Institut de l’EnvellimentUniversitat Autònoma de Barcelona. Casa de ConvalescènciaBarcelonaSpain

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