J Clin Neurol.  2019 Oct;15(4):517-526. 10.3988/jcn.2019.15.4.517.

The Influence of Body Mass Index at Diagnosis on Cognitive Decline in Parkinson's Disease

• Yoo HS
• Chung SJ
• Lee PH
• Sohn YH
• Kang SY

• KMID: 2467762
• DOI: http://doi.org/10.3988/jcn.2019.15.4.517

Abstract

BACKGROUND AND PURPOSE
Associations between alterations in body mass index (BMI) and cognitive function have been reported in Parkinson's disease (PD). We investigated whether the BMI at a PD diagnosis is associated with cognitive decline and the future development of dementia.
METHODS
We recruited 70 patients with de novo PD who underwent neuropsychological testing every 3 years and were followed up for more than 6 years. We classified patients into the following three groups based on their BMI at the diagnosis: under-/normal weight (n=21), overweight (n=22), and obese (n=27). We evaluated differences in the rate of cognitive decline over time among the groups using linear mixed models and the conversion rate to dementia using survival analysis.
RESULTS
The obese patients with PD showed a slower deterioration of global cognitive function as well as language and memory functions than did the under-/normal-weight group during the 6-year follow-up. The three BMI groups showed different rates of conversion to dementia (log-rank test: p=0.026). The combined overweight and obese group showed a lower risk of developing dementia compared with the under-/normal-weight group (hazard ratio= 0.36, 95% CI=0.12-0.82, p=0.046).
CONCLUSIONS
We have demonstrated that a higher-than-normal BMI at the time of a PD diagnosis has a protective effect against the deterioration of cognitive function and the conversion to dementia.

Keyword

body mass index; cognitive decline; neuropsychological test; Parkinson disease; Parkinson's disease dementia

MeSH Terms

Body Mass Index*
Cognition
Dementia
Diagnosis*
Follow-Up Studies
Humans
Memory
Neuropsychological Tests
Overweight
Parkinson Disease*

Figure

• 

  Fig. 1 Flowchart of the study patients with PD. PD: Parkinson's disease.

• 

  Fig. 2 Repeated-measures graphs for comparison of cognitive function among patients with PD grouped according to body mass index. *Significant group×time interaction. †Significant difference between under-/normal-weight and overweight groups. ‡Significant difference between under-/normal-weight and obese groups. Colored dot lines indicate a significant difference between the neuropsychological tests in the respective groups. CDR-SOB: Clinical Dementia Rating Sum of Boxes, MMSE: Mini Mental State Examination, PD: Parkinson's disease.

• 

  Fig. 3 Kaplan-Meier curves showing the cumulative probability of not developing dementia according to the duration of PD. A: The probability of being free of dementia among all patients and in the under-/normal-weight group (BMI <23 kg/m2), overweight group (BMI ≥23 kg/m2 and <25 kg/m2), and obese group (BMI ≥25 kg/m2). B: Comparison of the probability of being free of dementia between the under-/normal-weight and overweight/obese groups. BMI: body mass index, PD: Parkinson's disease.

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