Nutrition and Alzheimer’s Disease

By Anne Wright, Registered Dietitian

 

 

 

Introduction

Alzheimer’s disease (AD), the most common type of dementia, is characterised by a progressive cognitive decline that impacts the ability to function independently (1). Early symptoms of AD can include memory lapses, reduced concentration, and misplacing items. Symptoms progress over time to include increasing confusion, disorientation, mood and behavioural changes, difficulty performing simple tasks, significant loss of memory, gradual loss of speech, and loss of functional ability (2).

 

AD causes a high burden of suffering for both patients and their families (3). The eating and drinking difficulties that occur with AD are a particular source of stress for patients and their carers. Here we discuss the nutritional concerns, guidelines, and practical strategies for improving dietary intake for patients with AD.

Nutritional Concerns in Alzheimer’s Disease

Ensuring adequate nutrition and hydration is particularly important for patients with AD. Weight loss is a commonly reported consequence of AD, putting sufferers at risk of malnutrition (4). If not addressed, this can lead to greater functional impairment and dependence, and increased risk of morbidity, hospitalisation, institutionalisation, and mortality (5).

 

Weight loss in AD is largely due to symptoms affecting dietary intake. These include:

 

• Loss of appetite (6)
• Forgetting or refusing to eat (7)
• Communication problems (8)
• Being unable to recognise food and drink (9)
• Functional problems (e.g. difficulty using utensils) (7)
• Dysphagia (swallowing difficulties) (10)
• Frustration and/or anger when eating (6)
• Change in taste preferences (11)

 

Research shows that weight loss occurs from the earliest stages of AD (12), so nutritional interventions for AD should be followed in a timely fashion.

Guidelines for Nutrition and Alzheimer’s Disease

Patients with AD should be screened for malnutrition, and their weight should be monitored regularly (13). For adults at risk of malnutrition, nutritional guidelines (14, 15) recommend an energy intake of 25–35 kcal/kg/day and increasing protein intake, through food-first techniques and/or supplementation, to 1.0-1.5 g/kg body weight/day (for people who are not severely ill or injured, nor at risk of refeeding syndrome).

 

“Food first” techniques (16) include the encouragement of frequent meals, snacks and nourishing drinks, alongside food fortification. Fortifying food increases energy and/or protein by using everyday foods (such as butter, cream, cheese, milk powder and sugar) to enrich meals and snacks. Oral nutritional supplements, (ONS), are recommended when there is insufficient oral nutritional intake from normal food to improve nutritional status (15). ONS are available in a variety of forms such as high protein/energy powdered shakes and desserts.

 

The eating environment is important for encouraging food intake in AD. Meals should be adapted to individual preference and provided in a pleasant, homelike atmosphere with encouragement and support (13). Interventions including texture modification, the use of finger foods, assistance with eating and drinking, relaxed atmosphere, and food presentation should be utilised (17). The use of foods of bright and contrasting colours is important for patients with AD due to reported colour vision deficiency (18). Patients may be unable to recognise food or drink and may have trouble being able to distinguish food/drink offered in similar coloured plates and cups (e.g. milk in a white cup) (19).

Practical strategies for Carers

When supporting patients with AD, a number of strategies can be used to help improve dietary intake. These include:

Food and Drink Modifications:

• Offer small frequent meals
• Provide fortified food and drink and ONS, where indicated
• Include finger foods (e.g. buttered toast fingers, fruit slices)
• Consider modified textures (soft moist foods, thickened food and fluids)
• Provide choice including “nostalgic” and preferred foods
• Offer bright colour contrasts
• Serve one food at a time (serve meals in courses rather than all on a tray)

 

Eating Environment Modifications

• Reduce distractions (e.g. noise, crowds, clutter) (20)
• Offer frequent encouragement (e.g. company, gentle physical prompts, verbal cues and reminders to eat/swallow)
• Provide modified cutlery and utensils (21)
• Ensure correct and safe eating position (e.g.sitting up, check food has been swallowed)
• Encourage independence

Summary

A major source of stress for patients and their carers comes from the eating and drinking difficulties that occur with AD. Weight loss is a commonly reported consequence of AD, putting patients at risk of malnutrition.

 

Patients with AD should be screened for malnutrition, and their weight should be monitored regularly. Energy and protein intake can be improved through food-first techniques and the use of ONS and over-the counter nutritional shakes.

 

The eating environment is also important for encouraging food intake. Meals should be  provided in a pleasant, homelike atmosphere with encouragement and support. Practical interventions including texture modification, the use of finger foods, assistance with eating and drinking, relaxed environments and providing food in contrasting colours can be used to improve dietary intake for patients with AD.

References

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