Reader response: Early weight loss in parkinsonism predicts poor outcomes: Evidence from an incident cohort study

The article by Cumming et al.¹ showed prospective data on early weight loss in patients with Parkinson disease or atypical parkinsonism as a predictor of poor outcome. Early weight loss has been demonstrated in other neurodegenerative conditions, such as Alzheimer disease,² amyotrophic lateral sclerosis,³ and Huntington disease.⁴ Protein misfolding occurs early in many neurodegenerative conditions, likely determining increased brain metabolism. My colleagues and I hypothesized that such increased metabolic processes occurring in the brain could be related to increased brain temperature in early Parkinson disease.⁵ These findings about body weight reduction could further support this hypothesis, so that when the neurodegenerative processes kindle in patients' brains, misfolded proteins are produced and consequently destroyed because of dysfunction. This futile cycle increases brain temperature, and determines increased energy requirements and raising body metabolism, resulting in weight loss. It would be interesting to look for a correlation between brain temperature and weight loss to further investigate the issue.