cover story
An overview of nutritional
problems and interventions
in dementia from early
stages of the disease to
end of life
by Alison Smith
Specialist Dietitian
Peterborough Community Services
There are currently 700,000 people
with dementia in the UK, advises
Alison Smith specialises in oral nutrition support in elderly care
homes and in nutrition support in progressive neurological
The Alzheimer’s Society, and this
conditions. She is PR Officer for NAGE (a post that she also held
number will increase to more than between 2003 and 2007).
one million within 20 years.
This increase will be caused by a
growing elderly population and the least seems likely that poor appetite their corresponding nutritional prob-
fact that elderly people are living seen in many people in late stage lems.
longer. At the age of 65 to 70, preva- dementia is linked to plaques and In the early stage of the disease suf-
lence of dementia is one in 50, how- tangles within the hypothalamus – the ferers may:
ever over the age of 80 prevalence neurologic centre of appetite regula- • forget recent conversations or
increases sharply to one in five and tion (4). events which can include forget-
the number of people in the UK over It is also always important to ting mealtimes or forgetting that
the age of 85 is due to almost double remember that it is rare for an older they have already eaten;
within about the next 25 years (1). adult to suffer from dementia alone • become slower at grasping new
with no other co-morbidities, and ideas, or lose the thread of what is
Nutrition and dementia the problems and symptoms of the being said;
Difficulty in eating is known to be disease cannot be viewed in isola- • sometimes become confused,
a marker of advanced dementia (2), tion from other diseases and disorders show poor judgement, or find it
but dementia can have a very signifi- common in older adults (Figure 1). For harder to make decisions, all of
cant impact on nutritional intake and example, chronic constipation can which can make shopping, cook-
nutritional status even from a fairly have a significant impact on appetite, ing and storing food more difficult
early stage of the disease. In addition, but can be hard to identify in people and can lead to choosing inappro-
half of all people with dementia will with dementia (4). priate portion sizes, hoarding food
lose their ability to feed themselves or throwing it away;
within eight years of diagnosis (3). Stages of dementia • lose interest in other people or
Weight loss and malnutrition in late There are a number of types of activities which can include meal-
stage dementia are common, but the dementia with Alzheimer’s disease times;
full reasons why remain unclear as the being the most common. Alzheimer’s • become unwilling to try out new
nutritional problems seen are worse disease can be roughly divided into things or adapt to change which
than would be expected from poor three stages – early, middle and late can mean that unfamiliar foods are
nutritional intake alone. However, it at - and these can be mapped against rejected.
10 NHDmag.com Mar '10 - issue 52
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