Family Practice and Palliative Care

Öz

Introduction: Dementia is a health issue that has become increasingly prevalent worldwide due to the rising life expectancy. It leads to dependency and eventually death. Patients over the age of 65 with dementia are at increased risk of malnutrition due to various problems with food intake. Maintaining adequate nutritional intake and nutritional status during the disease is crucial. It has been noted that loss of muscle mass, accompanied by loss of body weight and functional decline, is associated with an increased risk of morbidity and mortality in dementia patients. Guidelines emphasize that nutritional interventions should be an integral part of dementia treatment. However, the increase in dependency situations in the later stages of dementia makes it difficult to measure weight and calculate the weight change. Although different scales and indexes can be used to assess nutritional status, there is no gold standard. It has been shown that Controlling Nutritional Status (CONUT) scoring, which is created by scoring serum albumin, total cholesterol, and total lymphocytes, can be used in the early diagnosis and follow-up of malnutrition in different patient groups. Therefore, this study aims to evaluate the correlation between the CONUT score and the Mini Nutritional Assessment-Short Form (MNA-SF) in determining the malnutrition status of dementia patients aged 65 and over who are followed up in a neurology outpatient clinic and to examine the relationship between the CONUT score and mortality.
Method: In the neurology outpatient clinic of a municipal day hospital, 113 patients aged 65 and over, out of 187 patients with a dementia diagnosis of at least one year, whose retrospective data were accessible, were included in the study. Their weight, height measurements, MNA-SF scores, serum albumin, total lymphocyte, and total cholesterol values were recorded from the system. The CONUT score was calculated based on biochemical data, and their three-month mortality statuses were checked from the e-Nabız system.
Results: The average age of the patients was 80.9 (±7.48) years, with 63.7% being female. Most of the patients had Alzheimer's type dementia (76.9%), and 53.9% had a body mass index (BMI) of <23 kg/m². According to the MNA-SF (≤7) and CONUT score (≥2), the malnutrition rates were 61.9% and 61%, respectively, and a negative correlation was found between them. A positive correlation was found between malnutrition determined by CONUT and the number of years with dementia, and weight loss of >5% in the last three months, while a negative correlation was found with BMI. Although there was no difference in the number of hospital admissions, those with malnutrition had a higher need for hospital admission (p=0.029). The mortality status of patients, regardless of age and years with dementia, was statistically significant with a CONUT score of ≥2 (0.63 (95% CI: 0.57-0.73)).
Conclusion: A negative correlation was shown between the CONUT score (≥2 points), calculated with biochemical markers, and the MNA-SF, which is recommended for frequent use in the elderly for determining malnutrition. The CONUT score's association with BMI and involuntary weight loss highlights its importance as an objective calculation method, particularly for dementia patients whose weight cannot be measured or known. It has been demonstrated that the CONUT score is related to mortality status regardless of age and years with dementia.