Nutritional Status is Associated With Severe Dementia and Mortality: The Cache County Dementia Progression Study

Abstract

Purpose: Studies have reported faster cognitive/functional decline in persons with dementia (PWD) with malnutrition. We investigated whether baseline nutritional status predicted severe dementia and mortality in a population-based sample.

Patients: A maximum of 300 PWD were assessed annually for up to 8.6 years.

Methods: Nutritional status was assessed using a modified Mini-Nutritional Assessment (mMNA). Severe dementia was defined as: "severe" rating on the Clinical Dementia Rating or Mini-Mental State Examination score ≤10. Using Cox proportional hazards models, we examined the association between baseline mMNA score (or its subcomponents) with each outcome. Covariates included demographics; dementia onset age, type, and duration; APOE genotype; and residency with caregiver.

Results: Compared with "well-nourished," "malnourished" PWD had 3-4 times the hazard of severe dementia [hazard ratio (HR), 4.31; P=0.014] and death (HR, 3.04; P<0.001). Those "at risk for malnutrition" had twice the hazard of severe dementia (HR, 1.98; P=0.064) and 1.5 times the hazard of death (HR, 1.46; P=0.015). mMNA subcomponents of food group intake, weight loss, body mass index, mobility, health status, protein consumption, and mid-arm circumference predicted one or both outcomes.

Conclusions: Nutritional status is an important predictor of clinical outcomes in dementia and may provide an avenue for intervention.

Figure 1

mMNA predicts time to severe dementia. Compared to those who are well-nourished at baseline, persons at risk for malnutrition are twice as likely and malnourished individuals are nearly three times as likely to die over the study follow-up.

Figure 2

mMNA predicts time to death. Compared to those who are well-nourished at baseline, persons at risk for malnutrition are about 1.5 times as likely and malnourished individuals are 3 times as likely to reach the endpoint of death.