Depression Linked with Malnutrition in Elderly with Parkinson’s, Study Finds

Depression and anxiety can be prevalent among elderly people hospitalized with Parkinson’s disease, and is associated with malnourishment or poor nutrition, a study from Germany suggests.

Findings also indicate that malnutrition is more prominent among men with Parkinson’s whose disease is more advanced or of a longer duration.

The study, “Association between malnutrition, clinical parameters and health-related quality of life in elderly hospitalized patients with Parkinson’s disease: A cross-sectional study,” was published in PLOS One.

Malnutrition broadly refers to a person’s diet that does not adequately provide their body with the nutrients it needs to function properly. In people with Parkinson’s, malnutrition can be a concern for reasons ranging from difficulty swallowing, or loss of smell and taste, to treatment side effects. In more advanced disease stages, these concerns often grow more pressing. Understanding the relationship between nutrition and disease parameters can help facilitate optimal care.

Researchers collected data from 92 elderly people with Parkinson’s disease (40 women, 52 men; average age, 73.6) without dementia, who were hospitalized at Jena University Hospital.

Measurements collected included assessments of motor symptoms (Movement Disorder Society-Unified Parkinson’s Disease Rating Scale), non-motor symptoms (Non-Motor Symptoms Questionnaire) that include depression (Beck’s Depression Inventory), and quality of life (39-item Parkinson’s disease quality of life questionnaire, abbreviated PDQ-39).

Nutritional status was assessed with the Mini Nutritional Assessment (MNA). This short questionnaire consists of six items: food intake in the past three months, weight loss during the past three months, mobility, psychological stress in the past three months, neuropsychological problems (i.e., depression or dementia), and body mass index.

The MNA’s brevity makes it easy to use in a hospital setting, and it has been validated as a way to measure nutritional status. But, the researchers noted, some of its drawbacks need be acknowledged.

“The sensitivity of the MNA is still debated because it has been related to a high risk of overdiagnosis of malnutrition,” they wrote.  Its emphasis on psychological problems, often without clear-cut definitions for what symptoms should correspond to a given score, can hinder the applicability of the MNA in Parkinson’s, whose psychological symptoms are common.

“Therefore, the MNA has limitations in some patients with PD when it is assessed independent of other measures,” the researchers wrote. They used it to obtain a more general snapshot of nutritional status among study patients, with adjustments based on independent measurements, such as depression or dementia.

Based on the MNA data, 6.5% of these 92 people were malnourished, and 39.1% were at risk of malnutrition. Malnutrition was significantly associated with male sex, longer disease duration, more advanced disease, and greater depression.

The researchers then created statistical models to examine the relationship between MNA scores and quality of life (PDQ-39 scores). These models controlled for factors including age, symptom severity (both motor and non-motor), depression scores, and disease stage.

A significant association was seen between MNA and PDQ-39 scores — that is, worse nutritional scores were statistically associated with poorer quality of life. When the researchers looked at different domains of the PDQ-39 individually, they found the strongest association between MNA and scores related to emotional well-being, implying that people with poorer nutrition are more likely to have worse emotional well-being.

“The emotional well-being domain is related to symptoms of depression and long-standing anxiety. Patients with depression are more likely to exhibit loss of appetite and decreased food intake, which can favor malnutrition,” the researchers wrote.

“Further studies in elderly patients with PD should therefore answer if the treatment of depression and anxiety beside diet and physical activity can help to improve nutrition status in these subjects,” they concluded.