The Unanticipated Challenge

    • Diagnosed with a stage of dementia?
    • Physical or cognitive decline?
    • Weight loss?

There are many challenges facing family carers of people with dementia, such as the financial, emotional, physical and time costs. Sometimes underestimated, or under-discussed, is the issue of the provision of nutrition to people with dementia. The difficulties in delivering nutrition to people with dementia, who are experiencing physical and cognitive decline, can often result in weight loss and malnutrition. As the disease progresses, these outcomes become more likely.

Recently, a group of researchers at Griffith University in Queensland, Australia, reviewed the body of literature regarding nutrition in dementia, to discover whether there were definitive factors in preventing the development of dementia, slowing its course, or preventing weight-related issues in people with dementia. The following outlines our findings.

Preventing dementia with nutrition

Currently, there are no evidence-based guidelines for the nutrition-related prevention of dementia. Similarly to many chronic diseases, a long-term high-calorie diet, a body weight above the healthy range and a high saturated fat intake are potential risks. For example, diabetes, cardiovascular disease, stroke, hypertension, as well as physical inactivity all increase the risk of developing some types of dementia. Diets higher in mono- and poly-unsaturated fats, omega-rich fish and the Mediterranean diet have been associated with lower rates of dementia, and antioxidants may also be protective against developing dementia. This is possibly due to the protective nature of these nutrients on our nerves, for example improving the conduction of nerve impulses. In addition, B vitamins and folate may lower our risk of developing dementia by reducing homocysteine (an amino acid which is often associated with cognitive decline) levels in blood.

You Might Like This:

Nutritional Strategies for Slowing the Course of Dementia

Research into nutritional strategies for slowing the course of dementia has received considerable attention in the last 10-15 years, however many of the findings are inconclusive or contradictory. As a result, we cannot definitively say that there are any nutrients which can slow the course of dementia. For example, some studies have assessed whether supplementation of B-vitamins/folate and energy/protein have an effect on cognitive decline. While many found an improvement in bio- markers such as homocysteine, this sadly did not result in any improvement in cognition in people with dementia. Recently, there has been renewed interest in energy restriction and cognitive decline. Unfortunately, only two studies have been published, one in healthy older adults and the other in older adults with mild cognitive decline. While there was a small improvement in verbal memory in both studies, it is not possible to recommend energy restriction in people with dementia, due to their significant issues maintaining weight, and increased risk of malnutrition.

You may also be interested in these articles relating to nutrition and dementia:

Dementia From Nutritional Deficiencies

The Best Foods For Dementia Patients

Omega-3 Fatty Acids May Prevent Dementia

Preventing Weight Loss in People with Dementia

There are many factors in dementia which can result in unintentional weight loss, including reduced appetite, difficulty swallowing, forgetting and/or refusing to eat, difficulty using utensils, behavioural issues and poor food safety practices. Preventing weight loss is a very challenging experience, especially for the family, and usually it is recommended that people with dementia receive oral nutrition supplements and assistance with preparing meals and feeding. These tactics are often useful in the earlier stages of dementia, however, in late-stage dementia they may not have an effect as eating function may be diminishing. It is recommended in the later stages of dementia that the focus of nutrition be on comfort – sips of water or other fluids, and easy to swallow foods which are enjoyed by the person with dementia. Artificial feeding (food and fluids through a tube) may sometimes be used in the later stages of dementia, but is a decision that needs to be made in consultation with the family. The majority of recommendations surround the provision of food, rather than the nutrients themselves.

Recommendations

The results of this review of the literature show that there are no specific nutritional recommendations that can be made in regards to the prevention or slowing of dementia. However, when it comes to the prevention of weight loss, there are several recommendations:

    1. Increasing food intake through the social nature of shared meal times
    2. Increasing the assistance given at meal times, including reminders to eat
    3. Delivering meals at the time of day when the individual appears most responsive
    4. Minimising distractions at meal times e.g. television
    5. Providing small frequent meals
    6. Providing finger foods that do not require cutlery, or soft and smooth foods that require less chewing
    7. Promoting self-feeding for as long as it is safe

(Adapted from Jansen S, Ball L, Desbrow B, et al., Nutrition and dementia care: Informing dietetic practice. Nutrition & Dietetics 2015; 72: 36-46).

It is also recommended that a family doctor be consulted for a referral to see a dietitian who is experienced in dementia care in the home. They will be able to provide specific recommendations to make meal times less challenging.