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A study of the nutritional status of elderly patients with Parkinson's disease

Age and Ageing, March, 1994 by Keren N. Davies, Debra King, Helen Davies

Introduction

Elderly patients with Parkinson's disease (PD) often lose weight. This not only adds to the morbidity of the parkinsonian patient (1) but undernutrition per se results in increased mortality (2, 3). The reasons for the weight loss have been little studied. Two studies have suggested an increase in energy expenditure (4)(5), other possible causes include dietary deficiency (6), malabsorption due to small-bowel bacterial overgrowth (7-9) and the presence of a circulating factor, e.g. tumour necrosis factor (10, 11). We studied a group of patients with PD who had lost weight to determine whether they showed evidence of undernutrition and to assess possible aetiological factors.

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Methods

Fifteen patients (nine women, median age 73.9 years, range 68.3-80.5 years) with PD who had weight loss documented in the medical notes, of at least 5 kg in the previous 12 months and 15 age- and sex-matched healthy control subjects (median age 73.6, range 67.6-80.3 years) were studied. The control subjects were randomly selected from general practice registers and luncheon clubs for older people. Eleven of the 15 patients were living with their spouse, three lived alone and one was resident in a nursing home. Nine of the control subjects lived alone, the remainder with their spouse.

Ethical approval was obtained from the Wirral Health Authority ethics committee. All subjects gave written informed consent.

All PD patients had at least two of the triad of tremor, rigidity and bradykinesia. All the patients were taking L-dopa to which they had had a good response. Their condition and medication had been stable for at least 6 months prior to study. Patients were excluded if they had swallowing disorders, gastro-intestinal disorder or malabsorption, metabolic disease, e.g. diabetes, thyrotoxicosis or other chronic disorders known to cause weight loss, e.g. chronic cardiac failure. PD was graded with the Hoehn and Yahr scale (12), and the Nottingham activities of daily living (ADL) scale (13) was completed for each patient. Disease duration and total daily dose of L-dopa were recorded. All the controls were screened, healthy elderly people on no medication. All tests were carried out by one of two investigators (K.D. or D.K.).

Anthropometric measurements: Height and weight were recorded and body mass index (BMI) was calculated as the ratio of weight (kg) to height [(m).sup.2]. Skin-fold thickness measurements were made at four standard sites (triceps, biceps, subscapular and supra-iliac) using Harpenden calipers. Three recordings were taken from each site and the mean recorded. Mid-arm circumference (MAC) was measured at the mid-point between the olecranon and acromion process. Body fat was estimated by the method of Durnin and Womersley (14). Arm muscle circumference (AMC) was calculated according to the formula AMC = MAC - (TSF x 0.314) where TSF is triceps skin-fold thickness.

Biochemical and haematological tests: Fasting blood samples were taken for albumin, calcium, serum alkaline phosphatase, total protein, urea, electrolytes and glucose (Excel analyser Indianapolis, USA), haemoglobin, MCV, total peripheral lymphocyte count (TPLC) (Bayer diagnostic technicon counter), ferritin (immuno-radiometric assay, IDS Ltd, Washington, Newcastle) red cell folate and serum [B.sub.12] (Biorad Quantaphase, radio-isotope dilution assay, Biorad Laboratories Ltd, Watford Hertfordshire) and thyroid function tests (immuno-radiometric assay, IDS Ltd). All these samples were analysed in one hospital laboratory.

Tumour necrosis factor: Plasma TNF was measured by indirect sandwich ELISA (15). Polyvinyl plates (Dynatech) were coated with an anti-human TNF alpha monoclonal antibody at 10 [micro]g/ml in 0.05 M sodium buffer, pH 9.6 for 16 h at 22[degrees]C. Plates were then washed in phosphate buffered saline plus 0.05% Tween-20(PBS Tween). After being blocked with 1% skimmed milk powder for 1 h and washed with PBS Tween, TNF alpha standards were added together with the samples at 1/100 dilution in 1% skimmed milk. The plates were incubated for 2 h at 22[degrees]C. Following washing with PBS Tween, a rabbit anti-serum against human TNF alpha was added at a dilution of 1/100 in 1% skimmed milk and incubated for 1 h at 22[degrees]C. After washing, peroxidase conjugated sheep anti-rabbit immunoglobulin (Silenus) was added at 1/5000 in 1% skimmed milk and incubated for 45 min at 22[degrees]C. Plates were washed again then incubated at 22[degrees]C with the peroxidase substrate, 0.03 mg/ml of 2,2-azino-di (3-ethyl-benzthiazidine sulphonate) in 0.1 M citrate buffer, pH 4, containing 0.02% hydrogen peroxide. The colour change was monitored at 405 nM using a Titertek Multiscan autoreader.

Dietary assessment: All subjects were interviewed by a dietitian and shown how to complete a dietary diary, using common household measures, e.g. teacups, tablespoons, to quantify food consumed. A 7-day diary was completed. The completeness of the diary was checked and any necessary supplementary information obtained by the dietitian at the end of the 7-day period. The data were analysed for mean daily intake of calories, protein, fat, carbohydrate, vitamins and trace elements by Compudiet (Scientific Hospital Supplies, Liverpool--software based on McCance and Widdowson's nutritional tables (16)).

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A study of the nutritional status of elderly patients with Parkinson's disease

Age and Ageing, March, 1994 by Keren N. Davies, Debra King, Helen Davies

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