Associations of nutritional parameters with clinical progression in patients with subjective cognitive decline, mild cognitive impairment and Alzheimer’s disease: The NUDAD project

Background Poorer nutritional status is more often observed in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) dementia compared to patients with subjective cognitive decline (SCD), but it is not known whether nutritional status contributes to clinical progression. Therefore, we investigated longitudinal associations of body mass index (BMI), fat‐free mass (FFM), modified Mini Nutritional Assessment (MNA) score and diet quality with clinical progression in a memory clinic cohort. Method We included 219 patients with SCD (age 61±8 years), 135 with MCI (66±8 years) and 197 with AD dementia (67±8 years), with a mean follow‐up of 2±1 years. Nutritional parameters at baseline were transformed into z‐scores. Progression was operationalized as presence of at least one of the following: 1) in SCD, progression to MCI or dementia; in MCI, progression to dementia; in AD dementia, an increase of ≥ 1 point on Clinical Dementia Rating scale; 2) passed away or admitted to a nursing home; 3) self‐reported progression of cognitive symptoms. We used age and sex adjusted Cox proportional hazard models in the total sample and stratified for baseline diagnosis. We performed a sensitivity analysis in amyloid positive patients to determine specificity of results for AD. Result Progression was observed in 25 (11%) patients with SCD, 45 (33%) MCI and 100 (51%) AD dementia. A lower modified MNA score was associated with a higher risk of clinical progression in the total sample (Table 1). Stratification revealed that the association was mainly attributable to patients with MCI and AD dementia. Lower BMI, FFM and diet quality score was associated with a higher risk of clinical progression in the total sample. After stratification on baseline diagnosis, significance was lost. In amyloid positive patients, a lower modified MNA score was associated with a higher risk of clinical progression, but there were no significant associations for BMI, FFM and diet quality with clinical progression. Conclusion Poorer nutritional status is associated with a higher risk of clinical progression, especially in patients with MCI and AD dementia. This observation provides support for future studies investigating whether improving nutritional status contributes to slowing down clinical progression.