1. Introduction

Instead of being a single illness, dementia [1] is a collection of conditions marked by progressively worsening cognitive abilities like memory, attention, planning, and decision-making. These cognitive deficits significantly impact patients' daily lives and their ability to perform self-care activities. This group of diseases, which includes Alzheimer’s disease [2], vascular dementia, and other neurodegenerative conditions, presents a serious challenge in both healthcare and social sectors, given the age-related nature of the disease and the high demand for long-term care and treatment [3,4]. In recent decades, scientific attention has increasingly focused not only on traditional aspects of dementia diagnosis and treatment but also on various additional factors that may influence the development and progression of the disease, as well as its severity. Among these factors are physical parameters, such as body mass and changes in body image, which may be related to neurodegenerative processes [5-7].

Body mass and body image perception play an important role in dementia research because changes in these indicators can serve as key markers of cognitive decline and overall health deterioration [8]. In dementia patients, various patterns of body weight changes are often observed, such as weight loss or, conversely, weight gain. These changes may be linked to dysfunctions in the hypothalamus or disturbances in metabolic processes characteristic of neurodegenerative diseases [9]. Therefore, body mass is not only an indicator of general health but also an important marker for assessing the disease’s prognosis. Studying the relationship between changes in body mass and cognitive impairments can provide valuable insights into the physiological changes occurring in the patient’s body. This, in turn, may aid in the development of new methods for early dementia diagnosis and monitoring its progression.

Body image assessment is another crucial aspect of dementia research, as changes in body perception in patients can be associated with cognitive and emotional disturbances. Patients with dementia often experience dysfunctions in how they perceive their own bodies, such as distorted body image, an inability to assess the size and shape of their body accurately, and changes in their attitude toward their appearance. These alterations may be related to neurodegenerative processes in the brain as well as cognitive decline, where patients lose the ability to accurately perceive the world around them and their place in it. Research indicates that shifts in how people see their bodies can have an impact on their emotional and psychological well-being, which makes them a crucial component of a thorough dementia diagnosis and treatment plan [10,12,13,14].

Therefore, a significant and little-studied factor that may help with dementia diagnosis and therapy is the relationship between physical characteristics like body mass and alterations in body perception in dementia patients. Future studies in this field will contribute to a greater understanding of the cognitive and physiological processes that underlie dementia. They may also help create new therapeutic approaches that will reduce the disease's course and improve patients' quality of life.

To find potential markers for early diagnosis and disease progression monitoring, the study will investigate the association between body mass, body image evaluation, MMSE, and CDR scores in patients with pre-dementia.

2. Method and Materials of the Study

Methodology: This study is a prospective observational research aimed at examining changes in body mass and its relationship with dementia in patients undergoing treatment and monitoring over a period of 90 days. The study employed clinical observation, questionnaires, and instrumental diagnostics. Participants' body mass was measured at three visits - at the first (Visit 1), second (after 30 days), and third (after 90 days) visits. Standard scales with an accuracy of 0.1 kg were used for body mass measurement. Dementia was diagnosed using standardized tests such as the MMSE (Mini-Mental State Examination) and CDR (Clinical Dementia Rating) scales, which allowed for assessing cognitive functions and the degree of dementia in participants. Additionally, the GDS (Geriatric Depression Scale) was used to assess the psychological and emotional state of participants.

MMSE (Mini-Mental State Examination) is a widely used tool to assess cognitive impairment in patients with dementia. It comprises 30 questions that assess many facets of cognitive function, such as language, memory, attention, time and place orientation, and the capacity to carry out productive tasks. The MMSE score ranges from 0 to 30, with a score of 30 indicating no cognitive impairment, while lower scores indicate varying degrees of cognitive dysfunction. The interpretation of the MMSE score is as follows: 24-30 points - normal cognitive function, 18-23 points - mild cognitive impairment, 0-17 points - severe cognitive impairment.

CDR (Clinical Dementia Rating) is used to assess the severity of dementia based on clinical manifestations. The scale includes 5 categories: personal care, communal affairs, memory, orientation, and judgment and problem solving. Five-point ratings are used for each category: 0 indicates no impairment, 0.5 indicates dubious impairment, 1 indicates mild impairment, 2 indicates significant impairment, and 3 indicates severe impairment. The CDR scale's results yield an overall score that divides patients into the following groups:

- CDR 0 - no dementia (normal state),

- CDR 0.5 - pre-dementia (mild cognitive impairment),

- CDR 1 - mild dementia,

- CDR 2 - moderate dementia,

- CDR 3 - severe dementia.

Statistical analysis of the data included calculating the average body mass, standard deviations, and assessing the dynamics of changes over the 90-day period. Specialized software was used to process the data.

Materials of the Study: The study included 20 participants with dementia who consented to participate and completed all three visits. The average age of the participants was 62.3±1.07 years, with an age range of 60 to 85 years. Among the participants, 8 were men and 12 were women. Participants' body mass was measured using digital scales. Cognitive functions were assessed using the MMSE scale, and the degree of dementia was assessed using the CDR scale. In addition to body mass data, coexisting conditions such as hypertension and diabetes were taken into account, as well as therapeutic interventions that could affect the study results.

3. Results and Discussion of Own Research

During the conducted study, changes in body weight, cognitive functions, and body image perception were recorded in patients with dementia over a 90-day observation period. Data were collected at three visits: at the baseline (first visit), after 30 days (second visit), and after 90 days (third visit). The results show interesting and important changes that may be associated with both the progression of the disease and other physiological processes.

Body Weight:

At the first visit, when the observation process began, the average body weight of the participants was 170.1±0.45 kg. This figure reflects the initial physical condition of the participants, which could have been influenced by various factors, such as lifestyle, diet, physical activity, and the presence of comorbid conditions such as hypertension, diabetes, and other chronic disorders. Given that most participants suffered from dementia, it is also important to note that age-related metabolic changes, reduced physical activity, and cognitive impairments can affect their initial physical state.

Table 1. Dynamics of body mass and cognitive function changes in patients with dementia

After 30 days, at the second visit, a significant decrease in body weight was observed, dropping to 81.2±0.66 kg. This 1.5-fold reduction in body weight could be associated with a variety of factors commonly seen in patients with dementia. One reason may be changes in appetite and eating habits, which are frequently observed in individuals with cognitive disorders. For instance, poor memory and attention, trouble identifying and orienting oneself when eating, and depressive symptoms can all cause one to drastically cut back on food consumption, which can result in weight loss. Furthermore, the control of appetite and metabolism can be directly impacted by neurodegenerative alterations in the brain, which may also lead to weight loss.

At the third visit, after 90 days, the body weight remained stable at 79.4±0.66 kg. This indicates that, despite the continued observation period, the rate of body weight loss slowed down. This could be related to the body's adaptation to the changes and stabilization of eating habits or physiological processes occurring in the patient's body. On the other hand, the slowing of weight loss could also reflect a decline in physical activity or a decrease in metabolic activity, which often happens in patients with advanced stages of dementia, where patients may become more passive and require assistance in daily life.

It is important to note that weight loss in patients with dementia has two aspects: on the one hand, it may result from insufficient nutrition and changes in appetite, and on the other hand, it may serve as an indicator of deeper issues related to the disease. Studies have shown that weight loss can accelerate the progression of dementia, as a reduction in body weight is associated with a decline in overall physical condition, nutrient deficiencies, and general body depletion, all of which can impact cognitive functions and overall well-being.

Thus, changes in body weight in dementia patients require careful monitoring, as this could be an important marker of deterioration in both physical and cognitive health. For people who have lost weight, a complete approach to treatment and care is required because it may be a sign of inadequate nutrition, depression, eating disorders, or the advancement of neurodegenerative processes.

Cognitive Functions:

An important part of the study involved assessing the cognitive abilities of participants using the MMSE (Mini-Mental State Examination). At the first visit, the average score on the MMSE was 19.6±0.67, indicating moderate cognitive impairment. This suggests that the participants in the study were at a stage where their cognitive functions had already begun to decline. Cognitive decline is one of the most significant hallmarks of dementia, and these results confirm that the patients were experiencing early-stage cognitive difficulties.

However, after 30 days, at the second visit, a small positive shift was observed, with the average MMSE score increasing to 20.3±0.46. This could indicate a slight improvement in cognitive functions or a change in how patients perceived their cognitive abilities. Such shifts may be due to various factors, such as stabilization of the disease or even the therapeutic interventions being administered. It is important to note that such changes, although modest, reflect the complex and dynamic nature of cognitive decline in dementia, where cognitive functions may fluctuate over time.

By the third visit, after 90 days, the average MMSE score had increased further to 22.3±0.57, suggesting some recovery of cognitive functions or at least a stabilization of their condition. Although dementia often causes cognitive decline, these findings imply that, with the right care, cognitive decline can occasionally be slowed or even partially reversed, especially if therapies are focused and successful. This demonstrates the possibility of partial compensation for cognitive impairments, especially with timely therapeutic interventions.

Despite the significant weight loss observed among the participants, the cognitive functions did not worsen significantly and even showed a trend toward improvement. This is an important observation, as it highlights that cognitive decline in dementia is not always directly correlated with physical changes, such as weight loss. In some cases, the brain may retain certain cognitive abilities even as the body undergoes changes, especially when the disease is managed with appropriate care and support.

The intricacy of dementia is shown by these findings, which show that cognitive function can differ from physical health markers such as body weight. It shows that cognitive skills can, under some circumstances, be stabilized or partially compensated for, which is vital for devising effective treatment procedures. Therefore, even though dementia frequently results in cognitive decline, the patient's quality of life can be enhanced and the rate of cognitive impairment slowed down with appropriate care and therapeutic approaches.

Functional Abilities (CDR):

The results of the CDR (Clinical Dementia Rating) scale, which is used to assess functional impairments in dementia patients, also showed an interesting trend. At the first visit, the average score on the CDR scale was 19.3±0.56, indicating moderate functional impairments in the participants. This suggests that at the beginning of the study, patients were already experiencing difficulties with daily activities, such as orientation problems, difficulties performing simple tasks, and ensuring their own safety. These functional impairments are consistent with the early stages of dementia, where patients begin to require assistance with routine tasks and may struggle with spatial orientation and memory.

After 30 days, at the second visit, a slight improvement was observed, with the average CDR score increasing to 20.7±0.40. This result may suggest partial stabilization of the patients’ condition or subtle improvements in their functional abilities. Such changes could be due to a variety of factors, including effective therapeutic interventions, increased patient engagement, or stabilization of the disease’s progression. The CDR scale is sensitive to changes in the ability to perform daily tasks, so even small improvements can have a meaningful impact on a patient's quality of life.

By the third visit, after 90 days, the average CDR score increased further to 22.6±0.47, indicating continued improvement or stabilization of functional abilities, despite the physical deterioration (weight loss). This finding may suggest that the patients’ condition was stabilizing functionally, or at least that they had adapted to the changes in their physical and cognitive states. Additionally, it may reflect the positive effects of therapies aimed at preserving or maintaining functional abilities in dementia patients.

The improvement in the CDR score despite the observed physical decline (weight loss) emphasizes the complexity of dementia, where cognitive and functional abilities can sometimes be maintained or even partially restored through proper therapeutic intervention. It is important to note that while dementia generally leads to a progressive decline in both cognitive and functional abilities, well-designed therapeutic approaches focused on rehabilitation and care can help slow down this decline and, in some cases, lead to stabilization or slight improvements in functional abilities.

These results underline the importance of addressing not only cognitive but also functional decline in dementia patients. The ability to maintain or restore functional capacity is essential for preserving independence and quality of life, highlighting the need for comprehensive care approaches that target both the physical and mental well-being of individuals with dementia.

Body Image Assessment:

An important aspect of the study was also the evaluation of participants' body image perception. Results from the Image evaluation (Body Image Assessment) scale showed a positive trend in how the participants viewed their bodies over time. Initially, during the first visit, the average score was 17.9±1.24, indicating that the participants had a certain level of disconnect between their actual physical state and their self-perception. This is common in the early stages of dementia, where cognitive changes can influence how individuals perceive their bodies, potentially leading to a distorted body image.

At the second visit, 30 days later, the average score increased to 19.2±1.05, reflecting some improvement in the participants' body image perception. This shift could suggest that, over the course of a month, patients started to adjust emotionally or psychologically to changes in their physical condition. Factors such as better emotional adjustment, cognitive adaptation, or even interventions focused on improving self-awareness may have contributed to this positive change.

By the end of the 90-day observation period, the average score had risen further to 21.2±1.10, indicating a sustained improvement in body image. This suggests that over time, the participants became more comfortable with the changes in their physical appearance. The continued improvement in body image perception might be attributed to a combination of psychological adaptation and support interventions, including emotional counseling or rehabilitation therapies aimed at promoting better self-awareness and acceptance.

Figure 1

The observed improvement in body image perception is significant because it highlights the potential for positive psychological changes in dementia patients, even in the context of cognitive and physical decline. A more favorable perception of one's body can enhance self-esteem, improve mental health, and foster greater social interaction. These findings underscore the importance of addressing emotional and psychological well-being in dementia care, alongside the more commonly discussed cognitive and physical aspects.

4. Conclusions

The study's findings show that, in spite of the weight loss seen in dementia patients, cognitive function as assessed by the MMSE scale, did not significantly deteriorate and even showed a trend toward improvement over the 90-day observation period. This suggests that, while physical changes such as weight loss can occur in patients with dementia, these changes do not always correlate directly with a decline in cognitive abilities. In fact, the improvement observed in the MMSE scores could indicate a temporary stabilization or slight recovery of cognitive functions, possibly due to therapeutic interventions or other factors such as psychological adaptation or changes in disease progression.

In parallel with the cognitive function assessment, improvements in functional abilities were observed, as indicated by the CDR scale scores. The positive changes in functional capacity are particularly important as they reflect the patient's ability to perform daily activities, which is a critical aspect of dementia care. The improvement in functional abilities suggests that despite the physical decline observed through weight loss, there may be other factors - such as targeted therapies, supportive care, or even a period of adaptation - that can help maintain or even improve functionality in dementia patients. This highlights the importance of a comprehensive approach to dementia care that focuses not only on cognitive decline but also on maintaining and enhancing daily living skills.

Moreover, it is crucial to recognize that weight loss, despite its generally negative trend, is not always a clear-cut indicator of deterioration in the patient’s condition. In dementia, weight loss can occur due to various reasons, including changes in appetite, metabolism, or the inability to recognize hunger. However, its effects on cognitive function may be more multifaceted than initially assumed. The relationship between weight loss and cognitive decline is complex and may not always be linear, suggesting that further research is needed to explore these connections in more depth.

The results of this study also emphasize the intricate relationship between physical health, cognitive functions, and body image perception in dementia patients. The observed improvements in body image perception, as measured by the Image evaluation scale, reflect the patients' emotional and psychological adaptation to their physical changes. These findings suggest that patients with dementia may, over time, adjust to the changes in their physical state and come to a more positive or stable perception of their bodies, even in the face of cognitive and physical decline. Future research must examine these aspects more thoroughly in order to better understand the underlying mechanisms and offer a more comprehensive approach to dementia care, as evidenced by the intricate relationship between physical health, cognition, and body image.

In conclusion, while weight loss and cognitive decline are common in patients with dementia, the study suggests that the relationship between these factors is not always straightforward. The improvements in cognitive function, functional abilities, and body image perception observed during the study point to the possibility of partial compensation or stabilization, even in the context of physical decline. This reinforces the importance of tailored therapeutic strategies and comprehensive care that address not only cognitive and physical health but also the emotional and psychological well-being of dementia patients. Further research is essential to fully understand these complex processes and to refine care models that optimize outcomes for individuals with dementia.

5. Findings

The study's conclusions show that while dementia patients experienced a significant decrease in weight during the 90-day observation period, cognitive function as assessed by the MMSE scale, did not deteriorate significantly. In fact, a slight trend toward improvement in cognitive abilities was observed. This suggests that the relationship between weight loss and cognitive decline in dementia is not straightforward. Furthermore, functional abilities as measured by the CDR scale increased throughout the trial, emphasizing how crucial it is to preserve patients' capacity to carry out everyday tasks. Additionally, improvements in body image perception, as evaluated by the Image evaluation scale, were recorded, indicating that dementia patients can experience positive psychological and emotional changes, even in the context of cognitive and physical decline.

These results emphasize the complexity of dementia, where physical decline, such as weight loss, may not necessarily correlate with worsening cognitive functions. The study also suggests that functional abilities and body image perceptions can improve or stabilize with appropriate care, despite cognitive or physical challenges. This complexity necessitates a more integrated and multifaceted approach to dementia care.

6. Practical Recommendations

1. Comprehensive Care Approach: Based on the findings, a holistic care approach should be adopted for dementia patients. It is essential to regularly assess cognitive functions, physical health, and psychological well-being. A comprehensive care plan that addresses these areas will be more effective in managing dementia and improving patients' quality of life.

2. Addressing Weight Loss: Although weight loss is often seen as a sign of physical decline, it should not automatically be interpreted as a negative indicator of cognitive function deterioration. Healthcare professionals should investigate the underlying causes of weight loss, such as changes in appetite, difficulty in eating, or metabolic alterations. Tailored interventions, including nutritional support, should be implemented to manage weight and prevent further complications.

3. Support for Emotional and Psychological Health: Considering the positive changes in body image perception observed in this study, it is crucial to address the emotional and psychological needs of dementia patients. Offering psychological counseling, emotional support, and therapies designed to enhance body image perception can significantly improve patients' self-esteem and overall mental health, which are key to their well-being.

4. Multidisciplinary Team Approach: Healthcare professionals must work together across disciplines due to the complexity of dementia care. A multidisciplinary team comprising doctors, psychologists, occupational therapists, and dietitians can offer a holistic approach to dementia care, attending to every facet of the patient's need.

5. Continuous Monitoring and Long-Term Care: Ongoing monitoring is critical for dementia patients, especially as cognitive, physical, and emotional changes can fluctuate over time. Regular follow-ups and assessments allow healthcare providers to adjust care plans as needed, ensuring that early signs of decline are addressed promptly. This proactive approach can significantly enhance the patient's quality of life.

Future Research Directions:

The results of this study underline the need for further research to better understand the complex relationship between cognitive decline, physical health, and emotional well-being in dementia. Future studies should focus on identifying the underlying mechanisms that lead to improvements in body image perception, functional abilities, and cognitive function. Additionally, investigating the role of weight loss and its impact on dementia progression will be crucial in developing targeted interventions to prevent or mitigate its effects.