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| |  DG DISPATCH - ISSSAT: Weight Loss A Significant Problem For Some Alzheimer's Patients By Cameron Johnston Special to DG News
STOCKHOLM, SWEDEN -- April 7, 2000 -- It's well-known that patients with Alzheimer's disease and other diseases of dementia lose weight. According to some studies, 90 per cent of patients lose at least 5 kg per year, and up to 50 per cent of all institutionalized patients with dementia are malnourished. Still, it's unclear whether the dementia causes weight loss, or whether weight loss is merely a symptom of the disease. Dr. Tommy Cederholm, a geriatrician in the department of geriatric medicine at Sweden's Karolinska Institute says that people with Alzheimer's disease have a higher metabolism than non-demented patients and, therefore, consume up to 25 per cent more calories per day. Dr. Cederholm spoke at the 6th International Stockholm-Springfield Symposium on Advances in Alzheimer Therapy (ISSSAT) this week. At the same time, however, these patients do not show signs of increased energy expenditure per day. Moreover, it has been shown that weight-loss begins up to 15 years before a person is diagnosed with Alzheimer's, which is well before any changes in either metabolism or daily caloric intake become apparent. This has lead doctors to investigate why patients with Alzheimer's lose weight at such a clinically significant, and potentially dangerous, rate. Dr. Cederholm suggested that this weight-loss could be due to an inflammatory process -- a suggestion that is gaining credibility given that inflammation is increasingly being presented as a potential cause for dementia. According to Dr. Cederholm, two substances, soluble interleukin-IL-1r-type II and tumor necrosis factor-alpha (TNF-a) are both elevated significantly in patients with Alzheimers disease. The substances are both indicative of cytokine activity, leading him to speculate that early weight loss before the diagnosis of Alzheimer's might be due to "low-grade cytokine activity -- an overflow of cytokines, leading to muscle catabolism." He added that, although to date no studies have specifically looked at whether cytokine activity has been related to weight loss in demented patients, it has been associated with significant loss of weight in patients with chronic obstructive pulmonary disease and cardiovascular disease. What is certain, he said, is that protein energy malnutrition is common in dementia. Furthermore, he said, at least two recent studies -- including one to be presented later at the Stockholm conference -- have shown that elderly people who receive food supplements each day may gain weight and improve their overall health. However, they have found that restoring nutritional balance does nothing to reverse the dementia once the process has started.
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