Early weight loss in parkinsonism predicts poor outcomes: evidence from an incident cohort study

Kirsten Cumming, Angus MacLeod (Corresponding Author), Phyo K Myint, Carl E Counsell

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Abstract

Objective: We aimed to compare weight change over time in Parkinson’s disease (PD), atypical parkinsonism, and matched controls; identify baseline factors that influence weight loss in parkinsonism; and examine whether it predicts poor outcome. Methods: We analysed data from the PINE study, an incident, population-based prospective cohort of parkinsonian patients and age-sex matched controls with annual follow-up. Mixed model analysis described weight change in PD, atypical parkinsonism and controls. Baseline determinants of sustained clinically-significant weight loss (>5% loss from baseline) and associations between early sustained weight loss and death, dementia and dependency in parkinsonism were studied with Cox-regression. Results: A total of 515 participants (240 controls, 187 PD, 88 atypical parkinsonism), were followed for median of 5 years. At diagnosis atypical parkinsonian patients had lower body weights than PD who were lighter than controls. Patients with PD lost weight more rapidly than controls and weight loss was most rapid in atypical parkinsonism. After multivariable adjustment for potential confounders, only age was independently associated with sustained clinically significant weight loss (HR, ten-year age increase, 1.83, 95% CI 1.44-2.32). Weight loss occurring within one year of diagnosis was independently associated with increased risk of dependency (HR 2.11, 95% CI 1.00-4.42), dementia (HR 3.23, 95% CI 1.40-7.44) and death (HR 2.23, 95% CI 1.46-3.41). Conclusion: Weight loss occurs in early parkinsonism and is greater in atypical parkinsonism than in PD. Early weight loss in parkinsonism has prognostic significance and targeted dietary interventions to prevent it may improve long-term outcomes.
Original languageEnglish
Pages (from-to)2254-2261
Number of pages8
JournalNeurology
Volume89
Issue number22
Early online date27 Oct 2017
DOIs
Publication statusPublished - 28 Nov 2017

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Parkinsonian Disorders
Weight Loss
Cohort Studies
Parkinson Disease
Weights and Measures
Dementia
Body Weight

Keywords

  • Parkinson’s disease/parkinsonism
  • prognosis
  • Natural history studies (prognosis)
  • weight loss

Cite this

Early weight loss in parkinsonism predicts poor outcomes : evidence from an incident cohort study. / Cumming, Kirsten; MacLeod, Angus (Corresponding Author); Myint, Phyo K; Counsell, Carl E.

In: Neurology, Vol. 89, No. 22, 28.11.2017, p. 2254-2261.

Research output: Contribution to journalArticle

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abstract = "Objective: We aimed to compare weight change over time in Parkinson’s disease (PD), atypical parkinsonism, and matched controls; identify baseline factors that influence weight loss in parkinsonism; and examine whether it predicts poor outcome. Methods: We analysed data from the PINE study, an incident, population-based prospective cohort of parkinsonian patients and age-sex matched controls with annual follow-up. Mixed model analysis described weight change in PD, atypical parkinsonism and controls. Baseline determinants of sustained clinically-significant weight loss (>5{\%} loss from baseline) and associations between early sustained weight loss and death, dementia and dependency in parkinsonism were studied with Cox-regression. Results: A total of 515 participants (240 controls, 187 PD, 88 atypical parkinsonism), were followed for median of 5 years. At diagnosis atypical parkinsonian patients had lower body weights than PD who were lighter than controls. Patients with PD lost weight more rapidly than controls and weight loss was most rapid in atypical parkinsonism. After multivariable adjustment for potential confounders, only age was independently associated with sustained clinically significant weight loss (HR, ten-year age increase, 1.83, 95{\%} CI 1.44-2.32). Weight loss occurring within one year of diagnosis was independently associated with increased risk of dependency (HR 2.11, 95{\%} CI 1.00-4.42), dementia (HR 3.23, 95{\%} CI 1.40-7.44) and death (HR 2.23, 95{\%} CI 1.46-3.41). Conclusion: Weight loss occurs in early parkinsonism and is greater in atypical parkinsonism than in PD. Early weight loss in parkinsonism has prognostic significance and targeted dietary interventions to prevent it may improve long-term outcomes.",
keywords = "Parkinson’s disease/parkinsonism, prognosis, Natural history studies (prognosis), weight loss",
author = "Kirsten Cumming and Angus MacLeod and Myint, {Phyo K} and Counsell, {Carl E}",
note = "This study was funded by Parkinson’s UK, the Scottish Chief Scientist Office, NHS Grampian endowments, the BMA Doris Hillier award, RS Macdonald Trust, the BUPA Foundation, and the Special Parkinson’s Research Interest Group (SPRING). The Article Processing Charge was funded by Parkinson's UK.",
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AU - MacLeod, Angus

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AU - Counsell, Carl E

N1 - This study was funded by Parkinson’s UK, the Scottish Chief Scientist Office, NHS Grampian endowments, the BMA Doris Hillier award, RS Macdonald Trust, the BUPA Foundation, and the Special Parkinson’s Research Interest Group (SPRING). The Article Processing Charge was funded by Parkinson's UK.

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N2 - Objective: We aimed to compare weight change over time in Parkinson’s disease (PD), atypical parkinsonism, and matched controls; identify baseline factors that influence weight loss in parkinsonism; and examine whether it predicts poor outcome. Methods: We analysed data from the PINE study, an incident, population-based prospective cohort of parkinsonian patients and age-sex matched controls with annual follow-up. Mixed model analysis described weight change in PD, atypical parkinsonism and controls. Baseline determinants of sustained clinically-significant weight loss (>5% loss from baseline) and associations between early sustained weight loss and death, dementia and dependency in parkinsonism were studied with Cox-regression. Results: A total of 515 participants (240 controls, 187 PD, 88 atypical parkinsonism), were followed for median of 5 years. At diagnosis atypical parkinsonian patients had lower body weights than PD who were lighter than controls. Patients with PD lost weight more rapidly than controls and weight loss was most rapid in atypical parkinsonism. After multivariable adjustment for potential confounders, only age was independently associated with sustained clinically significant weight loss (HR, ten-year age increase, 1.83, 95% CI 1.44-2.32). Weight loss occurring within one year of diagnosis was independently associated with increased risk of dependency (HR 2.11, 95% CI 1.00-4.42), dementia (HR 3.23, 95% CI 1.40-7.44) and death (HR 2.23, 95% CI 1.46-3.41). Conclusion: Weight loss occurs in early parkinsonism and is greater in atypical parkinsonism than in PD. Early weight loss in parkinsonism has prognostic significance and targeted dietary interventions to prevent it may improve long-term outcomes.

AB - Objective: We aimed to compare weight change over time in Parkinson’s disease (PD), atypical parkinsonism, and matched controls; identify baseline factors that influence weight loss in parkinsonism; and examine whether it predicts poor outcome. Methods: We analysed data from the PINE study, an incident, population-based prospective cohort of parkinsonian patients and age-sex matched controls with annual follow-up. Mixed model analysis described weight change in PD, atypical parkinsonism and controls. Baseline determinants of sustained clinically-significant weight loss (>5% loss from baseline) and associations between early sustained weight loss and death, dementia and dependency in parkinsonism were studied with Cox-regression. Results: A total of 515 participants (240 controls, 187 PD, 88 atypical parkinsonism), were followed for median of 5 years. At diagnosis atypical parkinsonian patients had lower body weights than PD who were lighter than controls. Patients with PD lost weight more rapidly than controls and weight loss was most rapid in atypical parkinsonism. After multivariable adjustment for potential confounders, only age was independently associated with sustained clinically significant weight loss (HR, ten-year age increase, 1.83, 95% CI 1.44-2.32). Weight loss occurring within one year of diagnosis was independently associated with increased risk of dependency (HR 2.11, 95% CI 1.00-4.42), dementia (HR 3.23, 95% CI 1.40-7.44) and death (HR 2.23, 95% CI 1.46-3.41). Conclusion: Weight loss occurs in early parkinsonism and is greater in atypical parkinsonism than in PD. Early weight loss in parkinsonism has prognostic significance and targeted dietary interventions to prevent it may improve long-term outcomes.

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