Dopamine Replacement and Nutrition in PARKINSON’S DISEASE
As PARKINSON’S DISEASE progresses and affected people age, maintaining proper nutrition becomes more challenging. A group of researchers from Rome, Italy studied a group of elderly people with PARKINSON’S DISEASE (PD) and found that fully one third of them were at risk for malnutrition. The authors are careful to state that they can draw no conclusive results nor establish any cause and effect relationship from their study of so small a sample group. But their observations are serious and pertinent and should be the basis for more extensive studies.
This study embraced a group of 75 elderly people with PD who attended a day care facility in a hospital center in Rome. All the subjects completed an informed consent and voluntarily participated in the study. Medical history and history of PD were carefully taken, together with questionnaires on the quality of life. They were asked about lifestyle habits such as history of smoking tobacco and/or drinking wine and screened for symptoms of depression. Medication history was also documented, with 69 subjects taking L-dopa, 56 were taking dopamine agonists and 50 of them were taking both L-dopa and an agonist.
Nutritional habits were documented using a standardized assessment and subjects were asked about their personal eating preferences. They were also asked if they had difficulty with chewing and if this difficulty had caused them to change their eating habits.
When the data from the study was tabulated, they found that 35% of the subjects taking L-dopa were at risk for malnutrition. Subjects taking higher doses of L-dopa and using only L-dopa were significantly more at risk of nutritional deficiencies. No association between dopamine agonists and malnutrition were established.
Researchers suggest there may be good reasons why the use of L-dopa therapies can contribute to malnutrition. Higher doses and long time use of L-dopa can lead to dyskinesias, which require a higher output of energy, and may also impair the subjects’ ability to chew. L-dopa can cause nausea, which may encourage anorexia. Other research has hypothesized a relationship between L-dopa and fat metabolism as well as on certain hormones that are involved in eating behavior. But they also suggest that perhaps age and duration of the disease contribute to poor nutritional status.
Dopamine agonists, on the other hand, might actually improve nutritional status. Weight gain has been associated with agonists and could actually encourage compulsive eating! Dopamine agonists also may alleviate depression, making eating more pleasurable and thereby improving nutrition and maintaining weight.
This study has been accepted pre-publication as a brief report in in the journal Movement Disorders.
Alice Laudisio MD1,*, Davide L. Vetrano MD2, Eleonora Meloni MD2, Diego Ricciardi PT2, Francesco Franceschi MD3, Anna Rita Bentivoglio PhD4, Roberto Bernabei MD2 and Giuseppe Zuccalà MD3 Dopaminergic agents and nutritional status in Parkinson’s disease; Mov.Dis. Article first published online: 12 SEP 2014 DOI: 10.1002/mds.25991
Review by Marcia McCall