Long-term cholinergic treatment is not associated with greater risk of weight loss during Alzheimer's disease: data from the French REAL.FR cohort.

BACKGROUND: An increased incidence of weight loss has been reported in patients with Alzheimer's disease (AD) treated with higher doses of acetylcholinesterase inhibitors (AChEI) compared with placebo patients in several clinical trials. The proportion of patients losing weight is extremely variable from one study to another and further analysis is necessary to reach a conclusion on the association of weight loss and AChEI.

OBJECTIVE: This observational study was designed to investigate the potential effects of AChEI use on weight loss during AD.

DESIGN: 486 patients with AD were followed for one year (initial mean age 77.3 +/- 77 years; initial mean MMS score 20.3 +/- 4.2). Comprehensive geriatric and neuropsychological assessment was conducted every 6 months. Cholinergic treatment was recorded at each visit, as well as any concomitant medication for dementia, psychotropic and other medications. We defined clinically significant weight loss as > or = 4% of the subject's initial weight based on the last measured weight. The data were initially evaluated categorically to identify those who had lost > or = 4% of their initial weight or had remained stable.

RESULTS: Eighty-nine per cent of AD patients were treated with AchEI during the first year of follow-up. Twenty-one per cent experienced clinically significant weight loss during this period. Weight loss was associated with more rapid deterioration of cognitive function (Delta MMSE -2.62 +/- 3.99 versus -1.72 +/- 3.64, P = 0.014) and loss of independence in instrumental activities of daily living (Delta IADL -1.45 +/- 1.50 versus - 0.88 +/- 1.43, P = 0.002). The frequency of weight loss was similar whether AD patients were treated with AChEI or not (respectively 21.1 and 19.5%, P = 0.81). In multivariate analysis, the risk of weight loss was significantly decreased in patients taking AChEI for more than 3 months compared (OR = 0.25, 95% CI = 0.11-0.56, P = 0.0007).

CONCLUSIONS: Our data suggest that long-term cholinergic treatment is not associated with greater risk of weight loss during AD and may be a protective factor. Further analysis is necessary to confirm this relation. It is obvious that the benefit observed might also be partly related to the organised non-pharmacological management provided for our patients, which included a specific care plan for each individual and facilitated response to nutritional problems as they occurred. Global care of AD patients must associate regular pluridisciplinary management with AChEI treatment.