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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.
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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

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