Weight loss and undernutrition in community-dwelling patients with Alzheimer’s dementia

Abstract

Weight loss and undernutrition are commonly described in patients with Alzheimer's disease (AD) and have been associated with various adverse outcomes. Therefore, it is important to know what the best approach is to community-dwelling AD patients with a risk of developing a poor nutritional status; however, there is currently no evidence on which to base nutritional recommendations. Expert based recommendations are that the nutritional status should be part of the work-up of all AD patients. If weight loss of 5% or more has occurred in 3-6 months or if the mini-nutritional assessment (MNA) classifies a patient as undernourished, a nutritional intervention should be started. The intervention should be multifactorial and encompass treatment of the underlying proposed causes and risk factors of weight loss and undernutrition as well as improvement of the nutritional status by increasing energy and protein intake combined with daily physical activity.

Acetylcholinesterase inhibitors are associated with weight loss in older people with dementia: a systematic review and meta-analysis

“…However, the incidence in both groups was relatively small (6% and 3%), particularly thinking that malnutrition and unintentional weight loss affect about half of the patients with dementia 54. Furthermore, the increased risk of weight loss was more evident in RCTs using DZP or GAL, with a longer follow-up period, while this was not observed in RCTs related to RIV.…”

Enteral feeding in neurological disorders

“…Important factors include memory loss, difficulty in planning and carrying out everyday tasks, problems with language, confusion with time or place, hallucinations, fluctuations in mood or behaviour, sleep disorders, apathy, anorexia, depression, swallowing difficulties, gait impairments and loss of independence 58. Malnutrition is associated with aggravated cognitive decline, shortened survival and reduced quality of life 4. Around 85% of all patients with advanced dementia experience feeding difficulties (eg, due to dysphagia, physical inability to prepare meals, loss of appetite, refusal to eat).…”

“…Malnutrition is a very common problem in patients with neurological disorders, such as stroke,1 motor neurone disease,2 Parkinson's disease,3 Alzheimer's disease and other dementias 4. The cause of malnutrition in these patient groups is multifactorial, including suboptimal dietary intake (because of dysphagia, lack of appetite, reduced mobility, requirement for an unpalatable diet, reliance on others and physical difficulties in preparing and consuming food); increased metabolism; physical exertion and other comorbidities affecting metabolic status 5 6.…”

Improving food intake in persons living with dementia

“…Yet, weight gain following diagnosis has also been seen, including in persons with aberrant motor behaviors (e.g., wandering), which can lead to increased energy requirements, but the maintenance of weight suggests that food intake can compensate for this increased activity . The lack of consistency in the recent research could be explained, in part, by the use of cholinesterase inhibitors in community‐living persons with dementia, which may decrease the risk of weight loss . In addition, there has been greater recognition of the potential for weight loss following diagnosis and the identification of risk factors for impaired food intake in community‐living persons with dementia; improved community services and their use may also explain why weight gain has been seen in some observational studies …”

“…Low food intake is believed to be a key mechanism for malnutrition in persons with dementia. Food intake studies in persons with dementia are extremely rare, potentially because of the challenges of collecting these data, especially in those living in the community .…”