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Nutrition for Alzheimer’s Disease

Most of us can say that our lives have been affected by Alzheimer’s disease or dementia in some way, and as America ages, the number of people affected by this condition continues to grow. The term dementia describes a variety of diseases and conditions that develop when neurons in the brain no longer function normally, causing changes in memory, behavior and the ability to think clearly. There are many types of dementia, but Alzheimer’s disease (AD) is the most common form, accounting for 60-80% of dementia cases. About 1 in 9 people age 65 and older, and 1 in 3 of people age 85 and older have AD.

Alzheimer’s disease is irreversible and progresses over time, progressing from mild to moderate to severe. Treatment can slow progression and sometimes help manage symptoms, but there is no cure. The time from diagnosis to death varies from as little as 3 or 4 years in older people to as long as 10 years in those who are younger when diagnosed. The cost of AD to the US health care system is significant. The average Medicare cost per person for those with AD and other forms of dementia is three times higher than for those without these conditions.

Risk factors for Alzheimer’s disease

Some risk factors for Alzheimer’s disease, such as age and genetic profile, cannot be controlled. However, certain lifestyle factors, such as a nutritious diet, exercise, social engagement, and intellectually stimulating pursuits, may help reduce the risk of cognitive decline and AD. Scientists are looking for associations between cognitive decline and heart disease, high blood pressure, diabetes and obesity. Understanding these relationships will help us understand whether reducing risk factors for these diseases can also help Alzheimer’s disease.

A growing body of evidence suggests that certain dietary components (such as antioxidant nutrients, fish, unsaturated fats, B vitamins, and omega-3 fatty acids) may help protect against age-related cognitive decline and AD. As research progresses, healthcare professionals may be able to recommend specific dietary and/or lifestyle changes to help prevent AD.

Medical Nutrition Therapy for Alzheimer’s Disease

A comprehensive nutritional assessment should be a routine part of the care of people with AD. A number of issues can affect the nutritional status of a person with AD, but each person will have a different nutritional diagnosis and nutritional prescription.

Medicines or ill-fitting dentures can affect food intake. As cognitive status declines, changes in neurological function can lead to problems with eating, such as reduced attention span, reasoning, and the ability to recognize feelings of hunger, thirst, and satiety. As AD progresses, the person may forget how to use eating utensils, forget to chew without verbal cues, and forget how to swallow. Motor skills may decrease, resulting in the need for feeding assistance. Moving around too much and not eating enough nutrients can contribute to the unintentional weight loss that is often inevitable in people with advanced dementia. Researchers think this is due to the disease process, although the exact reasons are not clear.

No single diet is recommended for the treatment of AD. Each person will need a unique set of nutritional interventions depending on their condition, symptoms and stage of disease. Possible interventions include:

• Change the dining environment: Provide a quiet environment, free of distractions. Limit choices by providing one plate of food at a time. Use colorful plates to differentiate the food from the plate.

• Frequent, nutrient-dense snacks. Fortified foods or oral nutritional supplements to provide extra calories to those who need them.

• Finger foods and/or adaptive feeding equipment to facilitate self-feeding, feeding and/or assisted feeding for those who need it.

• Consistently modified diets for people with difficulty chewing or swallowing.

Therapeutic diets that restrict sodium, concentrated sweets, or other dietary components are generally not recommended for people with end-stage AD because the primary goal of care is to prevent unintentional weight loss and provide the highest possible quality of life.

End of Life Nutrition Issues

As meal intake decreases in the person with advanced AD, families and/or caregivers may want to consider placement of a PEG tube for artificial nutrition and hydration. However, feeding tubes are rarely effective in improving nutrition, maintaining skin integrity through increased protein intake, preventing aspiration pneumonia, minimizing discomfort, improving functional status, or extending life in patients with dementia. . Based on the available evidence, most experts agree that hand feeding of food and liquids rather than tube feeding should be recommended for the best quality of life during end-of-life care. Despite the evidence, some families will request tube feeding. A registered dietitian nutritionist can provide information and guidance to help families make decisions about starting tube feedings and managing complications.

When a person with end-stage dementia is hand-fed, foods and liquids may need to be modified in consistency for easier eating or to manage swallowing problems. The person should be encouraged to eat foods that bring them comfort or are associated with pleasure or good memories. Unlike tube feeding, hand feeding may not meet 100% of a person’s nutritional and fluid needs. It can, however, satisfy other important basic needs such as enjoying the process of eating, appreciating the tastes and textures of food, human contact and interaction, and the routine of sharing a meal with others.

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