A diagnosis of Parkinson's disease carries with it a cascade of overlapping sequelae that are difficult to treat. An article in Nutrition and Clinical Care discusses the effect that one such problem - unwanted weight loss - can have on a patient's prognosis.

Gradual weight loss in a person with Parkinson's is likely due to multiple factors. There's the nerve dysfunction of the disease itself, which eventually reduces a person's ability to chew and swallow, and limits the ability to prepare food and handle utensils. Medications prescribed to control tremors can interfere with normal eating by causing nausea, taste changes, dry mouth, and fatigue. A fear of choking prompts some patients to avoid certain foods. In the disease's later stages, depression and cognitive changes can also interfere with normal nutrition.

Weight loss is a "slippery slope"

It can be difficult to stabilize weight in someone suffering from a chronic illness. But clinicians should consider unwanted weight loss to be an urgent "red flag" that the patient is consuming too few calories and is likely utilizing protein - sorely needed for cell repair - to meet energy needs. The subsequent loss of skeletal muscle, particularly in the quadriceps, further compromises the muscles needed to maintain balance.

Protein and calorie malnutrition makes the patient less able to fight off infection and compromises skin integrity, increasing the danger of pressure sores. Poor nutrient intake can also lead to decreased bone mineral density, which increases the chance of fracture in patients already unsteady on their feet.

Regular weight checks

The author stresses the importance of weighing patients with Parkinson's disease at each office visit. If weight loss is evident, consider the time frame over which the change occurred: Weight loss of more than 10% of premorbid body weight over six months, 7.5% over three months, or 5% over one month indicates that the person is at risk of malnutrition.

Other strategies

Have the patient or caregiver keep a 3-day intake diary of all foods and medications. This can be a useful tool in tracking down diet-drug interactions that may hinder a patient's ability to eat normally. Work with the patient to coordinate meal times and medication doses in order to limit side effects, such as nausea and esophageal reflux, that can be triggered by certain medications.

Refer patients with a history of weight loss promptly to the healthcare professional best able to address specific problems: a speech language pathologist to evaluate swallowing difficulties, an occupational therapist to provide adaptive eating utensils, or a registered dietitian to help plan texture-appropriate, nutrient-dense meals.

Encourage fluid intake. The same physical problems that produce weight loss also make it difficult for patients with Parkinson's disease to maintain proper hydration.

Consider the use of enteral nutrition support via percutaneous endoscopic gastrostomy (PEG) when the physical mechanics of eating and drinking become too difficult for the patient to control.