Nutritional Status is Associated with Faster Cognitive Decline and Worse Functional Impairment in the Progression of Dementia: The Cache County Dementia Progression Study¹

Article type: Research Article

Authors: Sanders, Chelsea^a | Behrens, Stephanie^a | Schwartz, Sarah^b | Wengreen, Heidi^c | Corcoran, Chris D.^{b; d} | Lyketsos, Constantine G.^e | Tschanz, JoAnn T.^{a; d; *}

Affiliations: [a] Department of Psychology, Utah State University, Logan, UT, USA | [b] Department of Mathematics and Statistics, Utah State University, Logan, UT, USA | [c] Department of Nutrition and Food Sciences, Utah State University, Logan, UT, USA | [d] Center for Epidemiologic Studies, Utah State University, Logan, UT, USA | [e] Department of Psychiatry and Behavioral Sciences, Bayview, Johns Hopkins University, Baltimore, MD, USA

Correspondence: [*] Correspondence to: JoAnn T. Tschanz, PhD, UMC 2810 Old Main Hill, Logan, UT 84321-4440, USA. Tel.: +1 435 797 1457; Fax: +1 435 797 1448; E-mail: joann.tschanz@usu.edu.

Note: [1] Presented in preliminary form at the 2013 Alzheimer’s Association International Conference, Boston, MA, USA.

Abstract: Nutritional status may be a modifiable factor in the progression of dementia. We examined the association of nutritional status and rate of cognitive and functional decline in a U.S. population-based sample. Study design was an observational longitudinal study with annual follow-ups up to 6 years of 292 persons with dementia (72% Alzheimer’s disease, 56% female) in Cache County, UT using the Mini-Mental State Exam (MMSE), Clinical Dementia Rating Sum of Boxes (CDR-sb), and modified Mini Nutritional Assessment (mMNA). mMNA scores declined by approximately 0.50 points/year, suggesting increasing risk for malnutrition. Lower mMNA score predicted faster rate of decline on the MMSE at earlier follow-up times, but slower decline at later follow-up times, whereas higher mMNA scores had the opposite pattern (mMNA by time β= 0.22, p = 0.017; mMNA by time2 β= –0.04, p = 0.04). Lower mMNA score was associated with greater impairment on the CDR-sb over the course of dementia (β= 0.35, p <  0.001). Assessment of malnutrition may be useful in predicting rates of progression in dementia and may provide a target for clinical intervention.

Keywords: Cognitive symptoms, dementia, disease progression, malnutrition, nutrition assessment

DOI: 10.3233/JAD-150528

Journal: Journal of Alzheimer's Disease, vol. 52, no. 1, pp. 33-42, 2016