Most of us can say that our lives have been touched by Alzheimer’s Disease or dementia in some way, and with the aging of America, the number of people affected by this condition continues to increase. 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 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 aged 65 and older, and 1 in 3 of those age 85 and older have AD.
Alzheimer’s disease is irreversible and is progressive over time, advancing from mild to moderate to severe. Treatment can slow the progression and sometimes help manage symptoms, but there is no cure. The time from diagnosis to death varies from as little to 3 or 4 years in older persons to as long as 10 years in those who are younger when diagnosed. The cost of AD to the U.S. health care system is significant. Average per-person Medicare costs for those with AD and other forms of dementia are 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, can’t be controlled. However, certain lifestyle factors, such as a nutritious diet, exercise, social engagement, and mentally stimulating pursuits, might help to 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 may also help with Alzheimer’s.
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 unfolds, health care professionals may be able to recommend specific diet and/or lifestyle changes to help prevent AD.
Medical Nutrition Therapy for Alzheimer’s Disease
A comprehensive nutrition assessment should be a routine part of the care of individuals with AD. A number of issues can affect the nutritional status of a person with AD, but each individual will have a different nutrition diagnosis and nutrition prescription.
Medications or poorly-fitting dentures can affect food intake. As cognitive status declines, changes in neurologic function can result in problems with eating such as impaired attention span, reasoning, and the ability to recognize feelings of hunger, thirst, and satiety. As AD progresses, the individual may forget how to use eating utensils, forget to chew without verbal cues, and forget how to swallow. Motor skills may decline, resulting in a need for feeding assistance. Excessive wandering and the inability to consume adequate nutrients may contribute to unintended weight loss, which is often unavoidable in those with advanced dementia. Researchers theorize that this is because of the disease process, although the exact reasons are not clear.
There is no one diet recommended for treatment of AD. Each individual will require a unique set of nutritional interventions depending on their condition, symptoms, and stage of the disease. Potential interventions include:
• Changing the dining environment: Provide a quiet environment, without distractions. Limit choices by providing one dish of food at a time. Use colorful dishes to differentiate food from the plate.
• Frequent, nutrient-dense snacks. Fortified foods or oral nutrition supplements to provide additional calories for those who need them.
• Finger foods and/or adaptive feeding equipment to facilitate self-feeding, cueing and/or feeding assistance for those who need it.
• Consistency-modified diets for those with chewing or swallowing difficulty.
Therapeutic diets that restrict sodium, concentrated sweets, or other components of the diet are generally not recommended in people with end-stage AD because the primary goal of care is to prevent unintended weight loss and provide the highest quality of life possible.
End of Life Nutrition Issues
As meal intake declines in the individual with advanced AD, families and/or responsible parties 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 suffering, improving functional status, or extending life in dementia patients. Based on the evidence available, most experts agree that hand feeding of food and fluids 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 of tube feeding. The registered dietitian nutritionist can provide information and guidance to help families make the decisions regarding initiating tube feeding and managing complications.
When a person with end-stage dementia is hand fed, food and fluids may need to be altered in consistency for easier consumption or to manage swallowing problems. The individual should be encouraged to consume 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 nutrition and fluid needs. It can, however, satisfy other important basic needs like enjoying the process of eating, appreciating flavors and textures of food, human touch and interaction, and the routine of sharing a meal with others.