Dramatic Weight Loss in a Patient With Parkinson Disease

Heidi Moawad, MD

Disclosures

July 25, 2019

Discussion

This patient rapidly lost more weight than the average patient with Parkinson disease. Thus, ruling out cancer or other disease processes was an important aspect of his evaluation and management. With other causes eliminated, his medical team focused on identifying and addressing Parkinson disease-related aspects of his weight loss.

Hyposmia is a diminished sense of smell. It is commonly seen in neurologic conditions, such as Parkinson disease, Alzheimer disease, Lewy body dementia, and stroke. Because smell is such an important component of taste, the loss of smell sensation can diminish a person's food intake. Of note, altered sense of smell has been reported in association with hyposmia, and some patients may develop an aversion to the smells of certain foods.

Parkinson disease itself can induce weight loss, even without diminished food intake. Although the pathophysiology is not well understood, weight loss has been described as part of the Parkinson disease process. In addition, some medications used for Parkinson disease, such as levodopa, may have a side effect of weight loss.[2]

Other causes of weight loss in Parkinson disease have also been recognized. Depression is fairly common in Parkinson disease and can result in a loss of appetite and deceased food intake owing to apathy and/or excessive sleep. Gastrointestinal disturbances have also been observed in Parkinson disease, including gastroesophageal reflux disease (GERD), constipation, and sialorrhea (excessive salivation or drooling).[3] All of these may cause difficulty eating and may result in decreased oral intake. Some patients with Parkinson disease may also experience dysphagia, which can cause difficulties eating and/or an aversion to eating. Many patients with Parkinson disease experience more than one of these symptoms, and the additive effects can have a substantial effect on appetite, metabolism, and the ability to safely swallow and eat.

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