OBJECTIVE

To determine the incidence of nutritional deficiencies in patients with Alzheimer’s disease (AD) and Parkinson’s disease (PD) and, if identified, to correct them.

MATERIAL AND METHODS

111 patients with neurodegenerative diseases AD and PD aged 50 to 89 years) were examined. Patients were examined twice: at the initial visit and 2 months later. During the first visit, a neurological examination and neuropsychological assessment were performed, and anxiety and depression levels were determined. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) questionnaire, and body mass index (BMI) was calculated. For laboratory confirmation of malnutrition, hemoglobin, albumin, lipid profile, urea, and creatinine levels were assessed. All patients at risk of malnutrition were given dietary recommendations. The patient’s family discussed adherence to a dietary regimen and maintaining a nutritious diet. To treat malnutrition, patients were also recommended to receive enteral nutrition supplements at a rate of 30-35 kcal/kg of body weight for outpatients (a total of at least 400 kcal/day) and 1 g of protein/kg of body weight/day. For this purpose, Fresubin protein was used, individually adjusted from 2 to 6 measuring spoons (12-36 g of protein). In the presence of dysphagia, depending on the severity of the swallowing disorder, a diet with a modified consistency was prescribed: Fresubin Cream 2 kcal, Fresubin Yogurt, Fresubin Condensed Level 2, and Fresubin Condensed Level 1. At the second visit (2 months later), treatment effectiveness was assessed.

RESULTS

Among the examined patients, AD was diagnosed in 66 (59.5%) patients, and PD in 45. (40.5%). malnutrition/risk of malnutrition was detected in 31 (28%) patients. In the group of patients with AD who had malnutrition/risk of malnutrition, 15 (62.5%) patients had malnutrition, 9 (37.5%) had the risk of malnutrition. Among patients with PD, 3 (42.9%) patients were diagnosed with malnutrition, 4 (57.1%) had the risk of malnutrition. Patients with AD who had moderate and severe dementia had significantly more often malnutrition and risk of malnutrition (p<0.05). Patients with PD at a more severe stage of the disease and, accordingly, with more pronounced movement disorders, had significantly more often malnutrition and the risk of malnutrition (p<0.05). A moderate correlation was obtained between dysphagia, oral apraxia, tooth loss, chewing disorder and malnutrition and the risk of malnutrition in patients with AD and PD (r=0.3, p<0.001). The value of laboratory parameters, such as increased creatinine, decreased albumin and hemoglobin, statistically significantly correlated with malnutrition and the risk of malnutrition (p<0.05). The study found a statistically significant association between depression, affective disorders, and malnutrition and the risk of malnutrition in patients with AD and PD (p<0.05). When examining patients malnutrition and the risk of malnutrition at the second visit, BMI increased in all patients.

CONCLUSION

Malnutrition and the risk of malnutrition occur in more than a quarter of patients with AD and PD. The risk of malnutrition increases in moderate and severe stages of the disease. Malnutrition is more common in AD compared to PD. Malnutrition and the risk of malnutrition were significantly associated with the presence of depression, affective disorders, as well as with chewing disorders, tooth loss, dysphagia, and oral apraxia. Early recognition of the risks of malnutrition is important for the timely correction of modifiable factors for the development of malnutrition, including the organization of adequate nutrition for the patient, dental prosthetics, Adjustment of the treatment regimen for the underlying disease, treatment of depressive episodes, and affective disorders. If a diagnosis of malnutrition is made, it is necessary to calculate and replenish the patient’s energy and fluid needs, including the inclusion of additional enteral nutrition in the comprehensive treatment strategy.