Hostname: page-component-669899f699-g7b4s Total loading time: 0 Render date: 2025-04-26T08:52:51.390Z Has data issue: false hasContentIssue false
  • English
  • Français

Malnutrition and neuropsychiatric symptoms in dementia: the Cache County Dementia Progression Study

Published online by Cambridge University Press:  29 May 2023

Kaitlyn Kauzor ,
Mikaela Drewel ,
Hector Gonzalez ,
Gail B. Rattinger ,
Alexandra G. Hammond ,
Heidi Wengreen ,
Constantine G. Lyketsos  and
JoAnn T. Tschanz Open the ORCID record for JoAnn T. Tschanz [Opens in a new window]
Kaitlyn Kauzor
Affiliation:
Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
Mikaela Drewel
Affiliation:
Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
Hector Gonzalez
Affiliation:
Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
Gail B. Rattinger
Affiliation:
School of Pharmacy and Pharmaceutical Sciences, Binghamton University, P.O. Box 6000. Binghamton, NY 13902-6000, USA
Alexandra G. Hammond
Affiliation:
Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA
Heidi Wengreen
Affiliation:
Nutrition Dietetics and Food Sciences, Utah State University, 8710 Old Main Hill, Logan, UT 84322-8710, USA
Constantine G. Lyketsos
Affiliation:
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine and Johns Hopkins Bayview Medical Center, 5300 Alpha Commons Drive, 4th Floor, Baltimore, MD 21224, USA
JoAnn T. Tschanz*
Affiliation:
Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321-2810, USA Alzheimer’s Disease and Dementia Research Center, Utah State University, 6405 Old Main Hill, Logan, UT, 84322-6405, USA
*
Correspondence should be addressed to: JoAnn Tschanz, Ph.D., Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84322-2810, USA. Email: joann.tschanz@usu.edu.
Get access

Abstract

Objectives:

Among people with dementia, poor nutritional status has been associated with worse cognitive and functional decline, but few studies have examined its association with neuropsychiatric symptoms (NPS). We examined this topic in a population-based sample of persons with dementia.

Design:

Longitudinal, observational cohort study.

Setting:

Community.

Participants:

Two hundred ninety-two persons with dementia (71.9% Alzheimer’s disease, 56.2% women) were followed up to 6 years.

Measurements:

We used a modified Mini-Nutritional Assessment (mMNA) and the Neuropsychiatric Inventory (NPI) to evaluate nutritional status and NPS, respectively. Individual linear mixed effects models examined the associations between time-varying mMNA total score or clinical categories (malnourishment, risk for malnourishment, or well-nourished) and NPI total score (excluding appetite domain) or NPI individual domain or cluster (e.g. psychosis) scores. Covariates tested were dementia onset age, type, and duration, medical comorbidities, sex, apolipoprotein E (APOE) genotype, and education.

Results:

Compared to the well-nourished, those at risk for malnourishment and those malnourished had higher total NPI scores [b (95% CI) = 1.76 (0.04, 3.48) or 3.20 (0.62, 5.78), respectively], controlling for significant covariates. Higher mMNA total score (better nutritional status) was associated with lower total NPI [b (95% CI) = −0.58 (−0.86, −0.29)] and lower domain scores for psychosis [b (95% CI) = −0.08 (−0.16, .004)], depression [b (95% CI = −0.11 (−0.16, −0.05], and apathy [b (95% CI = −0.19 (−0.28, −0.11)].

Conclusions:

Worse nutritional status is associated with more severe NPS. Dietary or behavioral interventions to prevent malnutrition may be beneficial for persons with dementia.

Keywords

dementiaAlzheimer’s disease (AD)nutritionneuropsychiatric symptomsbehavioral and psychological symptoms of dementia (BPSD)
Type
Original Research Article
Information
International Psychogeriatrics , Volume 35 , Special Issue 11: Issue Theme: Neuropsychiatric Symptoms of Mild and Major Neurocognitive Disorders , November 2023 , pp. 653 - 663
Copyright
© International Psychogeriatric Association 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Allen, V. J., Methven, L. and Gosney, M. A. (2013). Use of nutritional complete supplements in older adults with dementia: systematic review and meta-analysis of clinical outcomes. Clinical Nutrition, 32, 950–957. https://doi.org/10.1016/j.clnu.2013.03.015.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders.3rd, Revised.Google Scholar
Apostolova, L. G. et al. (2014). Risk factors for behavioral abnormalities in mild cognitive impairment and mild Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders, 37, 315–326. https://doi.org/10.1159/000351009.CrossRefGoogle ScholarPubMed
Bjoerke-Bertheussen, J., Ehrt, U., Rongve, A., Ballard, C. and Aarsland, D. (1987). Neuropsychiatric symptoms in mild dementia with Lewy bodies and Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders, 34, 1–6.CrossRefGoogle Scholar
Breitner, J. C. S. et al. (1999). APOE- 4 count predicts age when prevalence of AD increases, then declines: The Cache County Study. Neurology, 53, 321–321. https://doi.org/10.1212/WNL.53.2.321.CrossRefGoogle Scholar
Brocker, P., Benhamidat, T., Benoit, M., StaccinP, P., Bertogliati, C. and Gurrin, O. (2003). État nutritionnel et maladie d’Alzheimerrésultats préliminaires de l’étude REAL.FR. La Revue de Médecine Interne, 24, Suppl 3, 314s–318s.CrossRefGoogle ScholarPubMed
Cortes, F. et al. (2008). Prognosis of Alzheimer’s disease today: a two-year prospective study in 686 patients from the REAL-FR Study. Alzheimer’s & Dementia, 4, 22–29. https://doi.org/10.1016/j.jalz.2007.10.018.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2308. https://doi.org/10.1212/WNL.44.12.2308.CrossRefGoogle ScholarPubMed
Cummings, J. L. (1997). The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology, 48, 10S–16S. https://doi.org/10.1212/WNL.48.5_Suppl_6.10S,CrossRefGoogle ScholarPubMed
Delano-Wood, L. et al. (2008). APOE genotype predicts depression in women with Alzheimer’s disease: a retrospective study. International Journal of Geriatric Psychiatry: A Journal of the Psychiatry of Late Life and Allied Sciences, 23, 632–636.CrossRefGoogle ScholarPubMed
Dorner, B. (2010). Position of the American Dietetic Association: individualized nutrition approaches for older adults in health care communities. Journal of the American Dietetic Association, 110, 1549–1553. https://doi.org/10.1016/j.jada.2010.08.022.CrossRefGoogle ScholarPubMed
Eikelboom, W. S. et al. (2021). Sex differences in neuropsychiatric symptoms in Alzheimer’s disease dementia: a meta-analysis. Alzheimer’s & Dementia, 17, e055542.CrossRefGoogle Scholar
Fernández-Martínez, M., Castro, J., Molano, A., Zarranz, J. J., Rodrigo, R. M. and Ortega, R. (2008). Prevalence of neuropsychiatric symptoms in Alzheimer’s disease and vascular dementia. Current Alzheimer Research, 5, 61–69.10.2174/156720508783884585CrossRefGoogle ScholarPubMed
Gabryelewicz, T. et al. (2002). Behavioural pathology in Alzheimer’s disease with special reference to apolipoprotein E genotype. Dementia and Geriatric Cognitive Disorders, 14, 208–212.CrossRefGoogle ScholarPubMed
Gitlin, L. N., Kales, H. C. and Lyketsos, C. G. (2012). Nonpharmacologic management of behavioral symptoms in dementia. JAMA, 308, 2020–2029.CrossRefGoogle ScholarPubMed
Greenwood, C. E., Tam, C., Chan, M., Young, K. W., Binns, M. A. and Van Reekum, R. (2005). Behavioral disturbances, not cognitive deterioration, are associated with altered food selection in seniors with Alzheimer’s disease. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 60, 499–505.CrossRefGoogle Scholar
Guerin, O., Soto, M. E., Brocker, P., Robert, P. H., Benoit, M. and Vellas, B. (2005). Nutritional status assessment during Alzheimer’s disease: results after one year (the REAL French Study Group). The Journal of Nutrition, Health & Aging, 9, 81–84.Google ScholarPubMed
Guigoz, Y., Vellas, B. and Garry, P. J. (1997). Mini nutritional assessment: a practical assessment tool for grading the nutritional state of elderly patients. In: Vellas, B. (Ed.), The Mini Nutritional Assessment (MNA), Supplement 2 (pp. 15–60). Paris: Serdi Publisher.Google Scholar
Kales, H. C., Gitlin, L. N. and Lyketsos, C. G. (2014). Assessment DEP on the, Dementia M of the NS of. Management of neuropsychiatric symptoms of dementia in clinical settings: recommendations from a multidisciplinary expert panel. Journal of the American Geriatrics Society, 62, 762–769.CrossRefGoogle Scholar
Kales, H. C., Lyketsos, C. G., Miller, E. M. and Ballard, C. (2019). Management of behavioral and psychological symptoms in people with Alzheimer’s disease: an international Delphi consensus. International Psychogeriatrics, 31, 83–90. https://doi.org/10.1017/S1041610218000534.CrossRefGoogle ScholarPubMed
Kawano, Y. et al. (2020). Patient affect and caregiver burden in dementia. Psychogeriatrics, 20, 189–195. https://doi.org/10.1111/psyg.12487.CrossRefGoogle ScholarPubMed
Kimura, A. et al. (2019). Malnutrition is associated with behavioral and psychiatric symptoms of dementia in older women with mild cognitive impairment and early-stage Alzheimer’s disease. Nutrients, 11, 1951. https://doi.org/10.3390/nu11081951.CrossRefGoogle ScholarPubMed
Kishino, Y. et al. (2022). Longitudinal association between nutritional status and behavioral and psychological symptoms of dementia in older women with mild cognitive impairment and early-stage Alzheimer’s disease. Clinical Nutrition, 41, 1906–1912.CrossRefGoogle ScholarPubMed
Kwak, S., Park, S., Kim, J., Park, S. and Lee, J. Y. (2020). Multivariate neuroanatomical correlates of behavioral and psychological symptoms in dementia and the moderating role of education. NeuroImage: Clinical, 28, 102452. https://doi.org/10.1016/j.nicl.2020.102452.CrossRefGoogle ScholarPubMed
Lyketsos, C. G. et al. (2011). Neuropsychiatric symptoms in Alzheimer’s disease. Alzheimer’s & Dementia, 7, 532–539. https://doi.org/10.1016/j.jalz.2011.05.2410.CrossRefGoogle ScholarPubMed
Lyketsos, C. G. et al. (1999). The General Medical Health Rating: a bedside global rating of medical comorbidity in patients with dementia. Journal of the American Geriatric Society, 47, 487–491.10.1111/j.1532-5415.1999.tb07245.xCrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group* under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology, 34, 939–939. https://doi.org/10.1212/WNL.34.7.939.CrossRefGoogle ScholarPubMed
Miech, R. A., Breitner, J. C. S., Zandi, P. P., Khachaturian, A. S., Anthony, J. C. and Mayer, L. (2002). Incidence of AD may decline in the early 90s for men, later for women: The Cache County study. Neurology, 58, 209–218.CrossRefGoogle ScholarPubMed
Norman, K., Haß, U. and Pirlich, M. (2021). Malnutrition in older adults—recent advances and remaining challenges. Nutrients, 13, 2764. https://doi.org/10.3390/nu13082764.CrossRefGoogle ScholarPubMed
Román, G. C. et al. (1993). Vascular dementia: diagnostic criteria for research studies: report of the NINDS-AIREN International Workshop. Neurology, 43, 250–250.CrossRefGoogle ScholarPubMed
Roque, M., Salva, A. and Vellas, B. (2013). Malnutrition in community-dwelling adults with dementia (NutriAlz Trial). The Journal of Nutrition, Health & Aging, 17, 295–299.CrossRefGoogle ScholarPubMed
Salva, A. et al. (2009). Health and nutritional promotion program for patients with dementia (NutriAlz Study): design and baseline data. JNHA-The Journal of Nutrition, Health and Aging, 13, 529–537.10.1007/s12603-009-0103-0CrossRefGoogle ScholarPubMed
Sanders, C. et al. (2016). Nutritional status is associated with faster cognitive decline and worse functional impairment in the progression of dementia: the Cache County dementia progression study. Journal of Alzheimer’s disease, 52, 33–42.CrossRefGoogle Scholar
Sanders, C. L. et al. (2018). Nutritional status is associated with severe dementia and mortality: the Cache County Dementia Progression Study. Alzheimer Disease & Associated Disorders, 32, 298–304. https://doi.org/10.1097/WAD.0000000000000274.CrossRefGoogle ScholarPubMed
Spaccavento, S., Del Prete, M., Craca, A. and Fiore, P. (2009). Influence of nutritional status on cognitive, functional and neuropsychiatric deficits in Alzheimer’s disease. Archives of Gerontology and Geriatrics, 48, 356–360. https://doi.org/10.1016/j.archger.2008.03.002.CrossRefGoogle ScholarPubMed
Spalletta, G. et al. (2010). Neuropsychiatric symptoms and syndromes in a large cohort of newly diagnosed untreated patients with Alzheimer disease. The American Journal of Geriatric Psychiatry, 18, 1026–1035.CrossRefGoogle Scholar
Starr, K. N. P., McDonald, S. R. and Bales, C. W. (2015). Nutritional vulnerability in older adults: a continuum of concerns. Current Nutrition Reports, 4, 176–184.CrossRefGoogle Scholar
Steinberg, M. et al. (2008). Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. International Journal of Geriatric Psychiatry, 23, 170–177. https://doi.org/10.1002/gps.1858.CrossRefGoogle ScholarPubMed
Tao, Y. et al. (2018). Sex differences in the neuropsychiatric symptoms of patients with Alzheimer’s disease. American Journal of Alzheimer’s Disease & Other Dementias®, 33, 450–457.CrossRefGoogle ScholarPubMed
Terum, T. M., Andersen, J. R., Rongve, A., Aarsland, D., Svendsboe, E. J. and Testad, I. (2017). The relationship of specific items on the Neuropsychiatric Inventory to caregiver burden in dementia: a systematic review. International Journal of Geriatric Psychiatry, 32, 703–717. https://doi.org/10.1002/gps.4704.CrossRefGoogle ScholarPubMed
Tschanz, J. T. et al. (2011). Progression of cognitive, functional, and neuropsychiatric symptom domains in a population cohort with Alzheimer dementia: the Cache County Dementia Progression study. The American Journal of Geriatric Psychiatry, 19, 532–542.CrossRefGoogle Scholar
Tschanz, J. T. et al. (2002). An adaptation of the modified mini-mental state examination: analysis of demographic influences and normative data: the Cache County Study. Cognitive and Behavioral Neurology, 15, 28–38.Google ScholarPubMed
Vellas, B. et al. (1999). The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition, 15, 116–122.CrossRefGoogle ScholarPubMed
Vernon, E. K. et al. (2019). Caregiver-care recipient relationship closeness is associated with neuropsychiatric symptoms in dementia. The American Journal of Geriatric Psychiatry, 27, 349–359.CrossRefGoogle ScholarPubMed
Vlachos, G. S. and Scarmeas, N. (2019). Dietary interventions in mild cognitive impairment and dementia. Dialogues in Clinical Neuroscience, 21, 69–82.CrossRefGoogle ScholarPubMed
Westfall, J., Kenny, D. A. and Judd, C. M. (2014). Statistical power and optimal design in experiments in which samples of participants respond to samples of stimuli. Journal of Experimental Psychology: General, 143, 2020–2045.CrossRefGoogle ScholarPubMed