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• W2010756096 abstract "To the Editor: Alzheimer's disease (AD) is associated with weight lost of unknown etiology and low body mass index.1 It has been suggested that AD patients have higher resting energy expenditure (REE) and, consequently, higher energy requirements than healthy individuals.2 This may contribute to their unexplained weight loss, but it is unclear whether the weight loss is caused by a hypermetabolic state or by low levels of energy intake. However, the frequency of agitation and complications of intercurrent illness limit patient selection and development of standard measures. At the same time, these factors are potential explanations for weight loss. In a recent issue of the Journal, Barrett-Connor et al.3 report on a cohort study of normal subjects (n = 239) and AD patients (n = 73) who were considered to have mild to moderate dementia (mean Folstein Mini-Mental State Exam (MMSE) = 21.6 for men and 24.5 for women). Each group had weight histories of approximately 10 years duration. AD patients presented with weight loss 6 years before the diagnosis (−4.5 kg for men, and −3,2 kg for women), but no weight loss was found during the same period in the control group. This is strong evidence that weight loss is probably not a consequence of behavioral, cognitive, or acute problems associated with AD but a manifestation of the disease itself. Donaldson et al.,4 in the same issue, present a metabolic analysis of 25 AD patients with a history of weight loss and 73 older controls. They found no difference in resting metabolic rate or body composition between the AD patients and the normal control group. The daily energy intake was also the same for both. However, it should be noted that the AD patients were stable in their weight (at the moment of the study), which was not different from healthy aged controls. Thus, this study of a weight stable population, was primarily descriptive. Further studies in a population with active weight loss are required to define causality of weight loss in AD. To explore the cause of weight loss in AD, we studied 12 patients meeting NINCDS-ADRDA criteria for probable AD hospitalized in an “Alzheimer Intensive Care” unit. The reason for hospitalization was a history of weight loss without any other acute medical complication or nutritional or behavioral disorder. Daily energy intake was estimated from 3-day food records, resting energy expenditure was determined by indirect calorimetry under standardized conditions (after a 12-hour fast, with the last standardized protein-free meal at 18 to 20 hours), body composition was measured by anthropometric methodology, and total body water by impedance measures. Other tests designed to aid in the evaluation of metabolic status (thyroid function test), to exclude inflammation syndrome (leukocyte count, CRP and prealbumin levels), and to assess nutritional status (albumin, vitamin B12, folates) were normal in this group. All subjects ate normally and underwent a complete geriatric assessment that included the Folstein MMSE, Activities of Daily Living (ADL), and Mini-Nutritional Assessment scale (MNA, developed in our unit5). Patients' characteristics are showed in Table 1. Statistics determined were mean and standard deviation for descriptive purposes, simple linear regression for correlation between the different variables, and student t-test for comparison between groups of subjects. Alzheimer's disease patients presented with a weight loss of 4.25 kg ± 2.99 (mean ± SD) in ± 6 months. Folstein MMSE was 15.6, with a range of < 10 to 25. MNA scale was 19.45, with a range of 16 to 23. ADL scores showed moderate dependence (3.8 with a range of 1 to 6). The daily energy intake for AD patients was variable, with a range of 1207 to 2675 Cal/day (19–30.7 Cal/kg/day) for a mean of 1782 ± 462.6 Cal/day (25.9 ± 7.7 Cal/kg/day). The REE was 1313 ± 339 Cal/day (20.8 ±5.3 Cal/kg/day), which means ± 75% of daily energy intake. There was no correlation between history of weight loss and REE, daily caloric intake, fat-free mass, or body composition (P > .05). The severity of dementia (MMSE or ADL scores) was neither correlated with the weight loss nor with the REE (P > .05). There was also no correlation between nutritional status determined by MNA (all patients were at risk for malnutrition (n = 8) or were malnourished (n = 4)) and the daily caloric intake, the REE or the prealbumin and CRP levels (P > .05). In fact, REE was a variable independent of daily caloric intake, fat-free mass, or body composition, as well as nutritional status and severity of the AD. These results suggest that central regulation of body composition, weight, and normal capacity of energy balance is altered in AD patients (i.e., hypothalamus alteration or adipose metabolism). Further studies, addressed principally to the study total energy expenditure and metabolic regulations in AD, are required to determine cause(s) of weight loss in AD patients." @default.
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• W2010756096 date "1997-11-01" @default.
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• W2010756096 title "WEIGHT LOSS IN ALZHEIMER'S DISEASE AND RESTING ENERGY EXPENDITURE (REE), A PRELIMINARY REPORT" @default.
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• W2010756096 doi "https://doi.org/10.1111/j.1532-5415.1997.tb02953.x" @default.
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