Reduced Lean Mass in Early Alzheimer Disease and Its Association With Brain Atrophy

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Abstract
Alzheimer disease (AD) is associated with unintended weight loss1 that begins years prior to the recognition of AD-related clinical symptoms2-4 and may be a marker of preclinical AD.5 Weight loss in AD is associated with dementia severity and faster clinical progression.1 Epidemiological studies suggest a complex relationship between body composition and dementia that may be variable across the age spectrum. Although obesity in midlife is a risk factor for developing dementia,6,7 overweight and obesity in late life are associated with lower dementia risk.8,9 Most studies of body composition in dementia and AD are limited by nonspecific measures of body composition such as total body weight or body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) rather than specific measures of body fat and muscle mass. As normal aging is associated with increases in body fat and declines in lean mass without overall weight loss, nonspecific adiposity measures such as BMI have limited value in capturing these changes.