Relationship between cognitive impairment and nutritional assessment on functional status in Calabrian long-term-care

Abstract

ObjectiveThe interaction between dementia and nutritional state is very complex and not yet fully understood. The aim of the present study was to assess the interaction between cognitive impairment and nutritional state in a cohort of residential elderly in relationship with functional condition of patients and their load of assistance in long-term-care facilities of the National Association of Third Age Structures (ANASTE) Calabria.MethodsOne hundred seventy-four subjects (122 female and 52 male) were admitted to the long-term-care ANASTE Calabria study. All patients underwent multidimensional geriatric assessment. Nutritional state was assessed with the Mini Nutritional Assessment (MNA), whereas cognitive performance was evaluated by the Mini-Mental State Examination (MMSE). The functional state was assessed by Barthel Index (BI) and Activity Daily Living (ADL). The following nutritional biochemical parameters were also evaluated: albumin, cholesterol, iron, and hemoglobin. All patients were reassessed 180 days later.ResultsA severe cognitive impairment in MMSE performance was displayed in 49.7% patients, while 39.8% showed a moderate deficit; 6.9% had a slight deficit; and 3.4% evidenced no cognitive impairment. In MNA, 30% of patients exhibited an impairment of nutritional state; 56% were at risk of malnutrition; and 14% showed no nutritional problems. Malnutrition was present in 42% of patients with severe cognitive impairment, but only 4% of malnourished patients showed moderate cognitive deficit. The statistical analysis displayed a significant correlation between MNA and MMSE (P<0.001), as did MMSE correlated with Activity Daily Living (P<0.001) and BI (P<0.05). MNA correlated with BI (P<0.001) and albumin (P<0.001). The follow-up showed a strong correlation between cognitive deterioration and worsening of nutritional state (P<0.005) as well as with the functional state (P<0.05) and mortality (P<0.01).ConclusionThe present study clearly shows that malnutrition may play an important role in the progression of cognitive loss.

Nutritional Status is Associated with Faster Cognitive Decline and Worse Functional Impairment in the Progression of Dementia: The Cache County Dementia Progression Study1

“…In older adults with dementia, nutritional status has been found to predict cognitive, functional, and neuropsychiatric symptoms [6, 7, 12, 16, 17]. Using the multi-dimensional measure of malnutrition, the Mini-Nutritional Assessment (MNA) [18], many investigators have reported significant associations between degree of malnutrition and dementia outcomes.…”

“…A large multi-center French study reported that malnourished AD patients declined more rapidly on the Mini-Mental State Exam (MMSE) in a two-year follow-up [7]. Malara and colleagues [16], with the Italian National Association of Third Age Structures (Calabria) Study, found a significant correlation between the MNA and MMSE in patients with dementia at both baseline and 6-month follow-up. Several cross-sectional studies have found significant associations between poor nutritional status and behavioral disturbances [6, 12], worse cognitive status [12], and more impaired functioning in adult daily living activities [6, 12].…”

Asociación entre el estado nutricional según índice de masa corporal y deterioro cognitivo en adultos mayores del Centro Médico Naval del Perú, 2010-2015

“…Adicionalmente, un estudio realizado por Mantzorou et al, utilizando la escala Mini Nutritional Assessment -que incluye la medición de IMC-, encontró que el 11,3% de las personas mayores eran desnutridas y el 35% estaba en riesgo de desnutrición [26] . Recientemente, Avendaño estimó que el 18,6% de un grupo de adultos mayores padecía de desnutrición [9] , mientras que Malara et al encontraron que el 30% de un grupo de pacientes ancianos tenía desnutrición [11] .…”

“…Dosil et al, en un estudio realizado en 133 sujetos ancianos en Galicia, encontraron que el IMC se relacionó con el estado cognitivo evaluado por MMSE, y observaron, además, que mientras el IMC disminuía el deterioro cognitivo aumentaba [10] . Un estudio realizado entre 174 internos de un hogar de ancianos en Calabria-Italia por Malara et al apunta también hacia la misma conclusión, puesto que encontraron una fuerte correlación entre el deterioro cognitivo evaluado por MMSE y el empeoramiento del estado nutricional [11] . Otros estudios como el de Avendaño [9] en España y Mantzorou et al [26] en Grecia también muestran que el estado de desnutrición se asoció directamente con el deterioro cognitivo evaluado por MMSE.…”

“…El aspecto nutricional tiene un papel fundamental en el buen funcionamiento cerebral [9] . Diversas investigaciones encontraron que un estado de malnutrición está asociado a una mayor prevalencia de déficit cognitivo o deterioro cognitivo grave [10,11] . A nivel nacional, Guevara demostró que el estado nutricional del adulto mayor se asocia significativamente con el estado cognitivo y que hay un incremento del deterioro cognitivo condicionado a la obesidad [12] .…”