Date Published: October 2, 2018
Publisher: Public Library of Science
Author(s): Nedim Ongun, John Duda.
The aim of this study was to determine the relationship between nutritional status and Parkinson’s Disease (PD) features in association with depression, anxiety and quality of life in people with PD.
This study was conducted on 96 patients with idiopathic PD to whom the following scales were applied: Unified Parkinson’s Disease Rating Scale (UPDRS), 39-item PD questionnaire (PDQ-39), Hospital Anxiety and Depression Score (HADS), Mini Nutritional Assessment (MNA). The scales and measurements were applied to patients at their first assessment. Patients with malnutrition or at risk of malnutrition were assessed by the dietitian and nutrition nurse. These patients received nutritional support through personalized diet recommendations and appropriate enteral nutritional products, considering factors such as age, comorbidity, socioeconomic and cultural conditions. At the end of 6 weeks, the scales and measurements applied during the first visit were again applied to the patients.
A significant and inverse correlation was determined between mental (Spearman r:-0.510, p<0.001), activities of daily living (Spearman r:-0.520, p<0.001), motor (Spearman r:-0.480, p<0.001), complications (Spearman r:-0.346, p<0.001) UPDRS subdivisions and total scores (Spearman r:-0.644, p<0.001) and total MNA score. A significant and inverse correlation was found between all PDQ-39 subdomains and total MNA score (p<0.05). The highest inverse correlations were found in mobility (Spearman r:-0.690, p<0.001) and stigma (Spearman r:-0.570, p<0.001). Both depression (Spearman r:-0.631, p<0.001) and anxiety (Spearman r:-0.333, p<0.001) scores were determined to be inversely correlated with total MNA score. At the 6-week control visit, significantly lower scores were found in all subdivisions and in the total UPDRS score, PDQ-39 score and in the patients' anxiety and depression scores (p<0.05). MNA scores were found to be significantly higher in the assessment performed after 6 weeks of support for patients who had abnormal nutritional status at inception (p<0.001). PD motor and nonmotor functions, disease duration and severity are related to nutritional status. Quality of life was also shown to be affected by changes in the nutritional status. These results show that nutritional status assessment should be a standard approach in the PD treatment and follow-up processes.
Idiopathic Parkinson’s Disease (PD) affects several aspects of patients’ daily life because of its chronic nature . Quality of life (QoL) is associated with quality of health and is recognized as an important treatment outcome of many conditions . Therefore, health-related QoL has been considered an important outcome indicator for the management, care and progression of PD . Many studies have investigated the impact of several variables on health related QoL in patients with PD, including disease severity, motor symptoms, nonmotor symptoms and demographic and socioeconomic characteristics [4–8]. Few studies, however, have included the effect of nutritional status on QoL features in patients with PD [9,10]. For example, poor nutritional status has been shown to result in a lower QoL in elderly individuals [11,12]; and given people with PD are at risk of malnutrition, malnutrition in PD might contribute to poorer QoL [10,13]. Depression is also highly prevalent among patients with PD [14,15] reducing the QoL of the affected individuals . The aim of this study was to determine the relationship between nutritional status and PD features in association with depression, anxiety and QoL in people with PD.
This study was conducted on 96 patients with idiopathic PD which were recruited from an outpatient referral movement disorder clinic. This study was approved by Pamukkale University Medical School Non-Interventional Clinical Trials Ethics Committee. Investigation has been conducted according to the principles expressed in the Declaration of Helsinki. All of the collected data were stored according to the ethical guidelines of medical research. All patients were informed about the aims and procedures and provided their written informed consent to participate in this study. Participation in this study was voluntary and the patients were free to withdraw from the project whenever they wanted.
112 patients were screened for the study at the beginning and 16 patients were excluded during the follow up. 11 patients were failed to continue to diet program and/or oral supplements and 5 patients were clinically unstable during the follow up. 96 patients with PD (40 women (41.7%), 56 men (58.3%)) were included in the study. The average age was found to be 63.68 ± 6.41 years at the time of inclusion to the study and 52.2 ± 6.88 years at the beginning of the disease. Average disease duration was determined to be 9.04 ± 3.62 years. The average total UPDRS score was 43.25 ± 13.86. All demographic and baseline clinical characteristics were presented in Table 1.
According to the data obtained from our study, 67.7% of our patients had an abnormal nutritional status. In all subgroups of UPDRS and PDQ-39 scale which are used to define the severity of the disease and health related QoL in PD, higher scores were determined to be related to a poorer nutritional status. Similarly, people with lower MNA scores were found to have higher anxiety and depression scores. Depression, UPDRS score and male gender were determined to be independently related to malnutrition. A significant improvement was achieved in disease severity, QoL and nutritional status following nutrition education and support provided for patients with an abnormal nutritional status.