Definition of Dementia

Multiple cognitive defects including memory loss and at least one of the following: aphasia, apraxia, agnosia, and disturbance in executive functioning, severe enough to interfere with daily function. Of the nearly 50 common dementias of later life, the most common is Alzheimer’s disease (AD)

Dementia Prevalence

• 4 million Americans have AD
• 19 million Americans have a family member with AD
• One in ten over 65 years of age and nearly half over 85 have AD

Dementia Risk Factors

• Diabetes mellitus
• Cerebrovascular diseases, including stroke
• Family history
• Head injury
• Depression
• Hypertension
• Thromboembolism
• Hyperlipidemia
• Deficiencies of B-complex vitamins
• Female
• Age

Outcome Measures for Dementia

• Optimize ability to function to delay institutionalization
• Maintain BMI 22-27; may not be achievable in patients with advanced dementia
• Maintain hydration
• Reduce hospital admissions/readmissions

Dementia Therapeutic Objectives

• Maintain optimal weight, calorie and fluid intake
• Improve patient/caregiver satisfaction
• Minimize medication effects on food intake (OTC and prescribed)
• Prevent or decrease nutritional co-morbidities
• Maintain or increase functional status

Medications for dementia

• Cholinesterase inhibitors (donepezil, rivastigmine, tacrine or galantamine), frequently used in mild/moderate AD - may cause nausea, diarrhea
• Choose antipsychotics/antidepressants without anti-cholinergic side effects (dry mouth, delayed gastric emptying, constipation)
• Antidepressants may enhance appetite in depressed patients but SSRIs may cause a decrease in appetite

Supplements for dementia

• Consider B-complex supplements if deficiencies are suspected
• Vitamin E generally indicated in Alzheimer’s disease (2000 IU/day) unless contraindicated
• Consider vitamins/mineral supplements for older adults
• Consider high calorie, nutrient-rich foods or liquid supplements.

Dementia Lifestyle Modifications

• Consider the need for home services, assisted living/institutionalization, based on functional assessment ADLs/IADLs)*
• Consider altering the eating environment: reduce distractions, provide increased privacy, increase socialization, use special techniques for eating behavior problems

Dementia Nutrition Education

• Modify meal frequency, content and presentation as needed
• Use creative feeding strategies: e.g. serve frequent small meals/continuous access to food, offer one food at a time
• Adjust food texture (e.g. thicker liquids, finger foods)
• Offer high calorie, fresh, nutrient-rich foods

Treatment Options for dementia

• Nutrition Education
• Lifestyle Modifications
• Supplements
• Medications

Screening Parameters of Dementia

• Body weight assessmen

BMI < 22
Serum albumin < 3.5 g/dl
(often reduced by concurrent illness)

• Dietary intake of calories, protein, vitamins/mineralsFunctional status - Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)*
• Alcohol intake
• Cognitive, functional and behavioral assessment
• Ability to access/choose/prepare foods and need for feeding assistance
• Presence/absence of dysphagia or aspiration
• Use of vitamins/minerals and complementary/alternative therapies
• Depression

Note: Weight loss is a common early symptom of dementia and is frequently unrecognized in frail patients.