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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A number of studies have suggested that small-bowel bacterial overgrowth is implicated in malabsorption in elderly subjects even when the small bowel is anatomically normal (7)(20). It has been suggested that small-bowel bacterial contamination may result from ageing alone (20), achlorhydria with or without pernicious anaemia (7)(21) and reduced intestinal motility (21). Although the PD patients had significantly lower [B.sub.12]. levels none had evidence of pernicious anaemia. We have found a prolonged orocaecal transit time in patients with PD without evidence of small-bowel bacterial overgrowth [unpublished data].

The total peripheral lymphocyte count was significantly lower in the PD patients than in the controls. Changes in the immune system with ageing have been described yet are difficult to separate from the effects of associated medical conditions (22). Immunological studies of patients with protein calorie malnutrition have shown depressed lymphocyte counts, which are restored by dietary repletion (23). Although the PD patients only showed evidence of calorie malnutrition the change in TPLC suggests that immunological changes have occurred and the malnourished patients may be more susceptible to infections with consequent increases in morbidity and mortality. TNF (cachexin) is produced by monocytes in response to endotoxin and other membrane products and it has been suggested as the cause of metabolic abnormalities accompanying malignant neoplasms leading to cachexia (24). Elevated levels have subsequently been demonstrated in a variety of conditions including a variety of neoplasms (25), chronic heart failure (26)(27), chronic parasitic infections and acquired immunodeficiency syndrome (26) all characterized by anorexia and weight loss. In this small study we found no evidence of TNF contributing to weight loss in PD patients.

Patients with PD who lose weight show evidence of calorie malnutrition in spite of an increased calorie intake. Despite the patients being well controlled on medication we postulate that weight loss is due to an increase in metabolic rate or altered muscle metabolism.

Acknowledgement

We would like to thank Nicholas Laboratories, Roche Products Ltd, Broadwater Rd, Welwyn Garden City, Hertfordshire for supporting this study, Dr J. A. Barrett for allowing us to study his patients, and Mrs Linda Edward for her help with the dietary data.

References

(1.)Bastow MD, Rawlings J, Allison SP. Undernutrition, hypothermia and injury in elderly women with fractured femur: an injury response to altered metabolism? Lancet 1983;i:143-6.

(2.)Friedman PJ, Campbell AJB, Caradoc-Davies TH. Prospective trial of a new diagnostic criterion for severe wasting malnutrition in the elderly. Age Ageing 1985;14:149-54.

(3.)Campbell AJ, Spears GFS, Brown JS, Busby WJ, Borrie MJ. Anthropometric measurements as predictors of mortality in a community population aged 70 years and over. Age Ageing 1990;19:131-5.

(4.)Levi S, Cox M, Lugon M, Hodkinson M, Tomkins A. Increased energy expenditure in Parkinson's Disease. Br Med J 1990;301:1256-7.