The prevalence of malnutrition in Thai patients with alzheimer's disease

Abstract

Patients with Alzheimer's disease (AD) may have an increased risk for malnutrition, due to decline in cognition, loss of ability to help themselves, eating disorders and neuropsychological symptoms. Previous studies found that AD patients are associated with vitamin deficiencies. However, the relationship between the nutritional status and the stage of dementia in the elderly is still unclear. The objectives of this study were 1) to determine the nutritional status among Thai AD patients 2) to determine the relationship between nutritional status, vitamin and antioxidant levels, and stages of Alzheimer's disease 3) to determine the prevalence of malnutrition and stages of Alzheimer's disease. A cross-sectional study of 136 Thai AD patients in memory and geriatric outpatient clinics was conducted at Ramathibodi Hospital. The dementia severity was categorized into three levels - mild, moderate, and severe - according to the Global Deterioration Scale (GDS). Nutritional status was assessed by the Mini Nutritional Assessment (MNA), anthropometric measurements [body mass index (BMI), waist circumference, and bioelectrical impedance analysis (BIA)]. Blood biochemical analysis included general (Hb, Hct, serum albumin, FBS and lipid profiles; total cholesterol, HDL-C, LDL-C and TG) and specific (vitamin A, B1, B12, C, E, beta-carotene and folate) determinants of clinical and nutritional status. Mean age of study patients was 78.08 ± 7.47 years. 77.9% were female. According to the MNA classification, 50% of severe group were malnourished. An increased risk of malnutrition was also found in moderate group (57.8%). The mean MNA in the severe group was significant lower than those in the mild and the moderate groups (P<0.05). There was no significant difference between groups in anthropometric measurements. The severe group was more prominent in the underweight (31%), whereas overweight was found in mild group (45.6%). More than 50% of every stage of dementia were present with abdominal obesity. Most of blood biochemical analyses were within the reference ranges. However the differences between groups were not found. Hb, Hct and serum Alb levels in the severe group were significantly different from the mild and the moderate group (p < 0.05). From the 24hr-recall dietary assessment, there were no significant differences in energy and nutrient intakes between groups. In this study, most presented a nutritional status of malnourished in severe groups. This study demonstrates the current and limited data of nutritional status both in underweight and overweight in Thai AD patients with some significant clinical markers in the severe group. The findings of high levels of vitamins were necessary to verify in order to create an overall nutritional strategy for AD treatment. Because malnutrition is a common problem in AD patients, some strategies can be adopted to improve the nutritional status of these patients. These strategies include patient and caregiver nutritional education programs, and the use of oral nutritional supplements, which can significantly impact nutritional status by reducing the prevalence of malnutrition in AD patients. Therefore, more studies are needed to be done in this area in the future.