脳卒中とアルツハイマー病における悪液質

今日は、5th Cachexia Conferenceの資料の中から、脳卒中とアルツハイマー病における悪液質の抄録を紹介します。

http://www.lms-events.com/19/5th_Cachexia_Conference_2009_Abstracts.pdf

私は脳卒中とアルツハイマー病で悪液質が生じるという話は聞いたことがありませんでした。実際、この抄録を読んでみても脳卒中患者の栄養・体重管理の記載のほうが多く、悪液質に関する研究はほとんどないという記載です。

確かに重症認知症で末期に高度のるいそうを認める患者はいますが、これを悪液質と考えたことはありませんでした。脳卒中単独やアルツハイマー病単独では、通常炎症反応（CRP）も陰性のことが多い印象があります。もしCRPが持続的に陽性の脳卒中やアルツハイマー病の患者がいたら、要注意ですね。

現時点では脳卒中とアルツハイマー病で悪液質が生じるという考えは、未検証の仮説と解釈したほうがよいと思います。悪液質かどうかに関わらず、脳卒中とアルツハイマー病では体重減少を認めることがあるため、そのような患者では適切なリハ栄養管理を要するということです。

Cachexia in stroke and Alzheimer’s disease
Wolfram Döhner
Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany

Patients with stroke suffer from an acute event that frequently results in severe bodily impairment as well as a reduction in quality of life. While acute therapy and early neurological rehabilitation have improved substantially in recent years, patients live after the event in a chronic diseased state for a prolonged period of time. Significant adaptations of global regulatory mechanisms such as metabolic and immunologic regulation and of peripheral organ and tissue functions such as muscle and fat tissue may occur. Systemic abnormalities develop secondary to maladaptive processes in the long-term course of the disease and feedback signals may fuel a vicious self-enhancing cycle. As shown in other chronic diseases, those changes and mal-adaptations may affect the whole body and significantly contribute to symptomatic status and disease progression independent of the site (organ) of the initial event. Tissue wasting particularly of muscle tissue is often observed in chronic diseases contributing to functional impairment and development of cachexia.

While research in stroke is predominantly focused on prevention and treatment of the neurological failure, peripheral and systemic metabolic and functional changes are less well investigated. Few data are available on the epidemiology of weight change in stroke or on its pathophysiology or possible therapeutic approaches. Current German guidelines on primary and secondary prevention of stroke admit a complete lack of controlled data to support evidence-based recommendations on weight management in patients after stroke. Regardless of the lack of evidence weight loss is recommended in current secondary prevention guidelines. Further research is needed to establish evidence based weight management recommendations in stroke.