Protibis

Alzheimer's disease and nutrition

Alzheimer patients frequently suffer from a poor oral status

Which increses the risk of malnutrition: swallowing problems, smell and taste alterations, edentulousness...
They like finger food and pecking at Protibis cookies

 Abstract

Weight loss is one of the first symptoms of Alzheimer’s Disease: affected elderly forget to shop groceries, forget meal time, and how to use forks and spoons as well as the smell and taste of food. AD patients frequently cumulate a poor oral health and swallowing disorders (1,2).Weight loss affects 30 to 45% of AD patients, mainly roaming people, and it worsens with the evolution of the disease (3-5). Protein-rich and energy-rich oral nutritional supplements (ONS) are helpful in fighting malnutrition among AD patient (5,6). However, AD patients must be spoon-fed, which constitute an additional workload for family or nursing staff (1,7). Finger food is a good alternative for these patients (8).

 

Article : Philip JL. [Fighting malnutrition of Alzheimer’s Disease patients : an exemple]. La Revue de Gériatrie 2012 ;37 :141-2. French

 

The symptoms of Alzheimer’s disease (1,2)

Alzheimer’s disease (AD) is a degenerative disease affecting the brain and characterized by the insidious onset of dementia. Impairment of memory, judgment, attention span, and problem solving skills are followed by a global loss of cognitive abilities and incapacity to make a movement or a serie of movements (severe apraxias).

The brain presents a severe cortical atrophy, with amyloids plaques which form between neurons (senile plaques) and aggregates of tau proteins inside neurons (neurofibrillary tangles and neutropil threads). The condition primarily occurs after age 60.

The clinical phase of the disease is often preceded by a phase called Mild Cognitive Impairment (MCI). Patient’s complains and objective signs reveal changes of one or several cognitive domains, such as difficulties remembering recent events, but the daily activities are preserved.

The patient then presents difficulties to communicate and his behavior deteriorates inexorably, forcing the family or nursing staff to a continuous assistance. Roaming patients walk endlessly. Life expectancy is from 3 to 8 years.

Several risk factors have been established for AD. Some are not changeable: age, female gender and genotype. Some are potentially changeable: vascular risk factors (hypertension, smoking, diabetes, atrial fibrillation and obesity) and head injury. Protective factors include: use of antihypertensives and non-steroidal anti-inflammatories, high education, diet, physical activity and engagement in social and intellectual activities.

 

Alzheimer’s Disease treatments (1,2)

According to EFNS, no treatment has demonstrated efficiency for preventing or delaying the development of AD in MCI subjects. Treatment of established AD comprises: 1) cholinesterase inhibitors (donepezil, rivastigmine, galantamine), 2) memantine, a non-competitive N-methyl-aspartate receptor antagonist; 3) cognitive therapies (cognitive stimulation). The pharmacologic treatment is presently debated. The treatment of behavioral and psychological symptoms of dementia relays on the search and treatment for triggering and/or worsening factors including environmental conditions, physical problems (infections, constipation), medication and depression or psychosis. There are high placebo response rates, and medical staff is encouraged to try safe non-pharmacological management (education, exercise, aromatherapy, sensory stimulation, personalized music). Antipsychotics (risperidone for agitation and psychosis) and antidepressants, especially selective serotonin reuptake inhibitors, may be necessary.

The patient quickly becomes dependent (See the site France Alzheimer). He has to be the object of a continuous assistance by the family or the helping persons, then if possible accommodated in a nursing home for dependent elderly.

 

Alzheimer’s Disease, malnutrition and anorexia

For Alzheimer patients, malnutrition ranges from 30 to 45%. It may be an early symptom of AD, which sometimes appears before other cognitive or behavioral symptoms of the disease. Weight loss generally starts with troubles for correct feeding. The loss of orientation in time and space causes difficulties for shopping and meal cooking (1,3).

AD patients may cumulate all the risks of malnutrition: alteration of cognitive functions, frequent acute and chronic diseases, poverty and social isolation, the use of more than 3-4 drugs/day, smell, taste, vision, audition and motor alterations, increased energetic needs for roaming patients and oral problems (swallowing difficulties, dry mouth, oral pain, periodontitis and teeth mobility, edentulousness and poorly fitting dentures) (1,3,11,12). Murphy described a loss of taste and smell memory, and smell if more affected than taste by memory impairment (12). Hearing is involved in food perception too. Alzheimer patients have an intact tone perception but a progressive decline in working memory for auditory verbal and non-verbal information (13).

 

Fight malnutrition of Alzheimer’s Disease patients

Malnutrition can oblige to hospitalize or to place prematurely Alzheimer patients in institution. Weight loss worsens with dementia progression, with an increased frequency of falls, infections (inhalation pneumonia, bedsores), fatigue, dependence, depression and mortality (4).

Oral nutritional supplements (ONS) help to fight the malnutrition of AD patients (5,6), but feeding help for meals is an additional workload for the family or nursing staff, because patients must be spoon-fed (7). Finger food which can be picked in the hand is useful for these patients (8). A study in a nursing home showed that AD patients appreciated finger food presented in the form of small portions, colored or two-colored portions and soaking into a sauce. On the other hand, AD patients did not express any preference for soft or spiced food (8). Besides, regardless cognitive disorders, AD patients like to manipulate food and participating in the preparation of the meals (14). Similar results were observed with Protibis cookies, which are small, golden, easy to pick and to dip into a beverage (9).

 

References

1. HAS : Haute Autorité de Santé. Plan Alzheimer 2008-2012. Recommandations professionnelles. Diagnostic et prise en charge de la maladie d’Alzheimer et des maladies apparentées. Mars 2008.

2. Hort J, O’Brien JT, Gainotti G et al. European Federation of the Neurological Societies. EFNS Panel on Dementia. EFNS guidelines for the diagnosis and management of Alzheimer disease. Eur J Neurol 2010;17:1236-1248.

3. Raynaud-Simon A, Lesourd B. Dénutrition du sujet âgé. Conséquences cliniques. Presse Méd 2000 ; 29 :2183-90.

4. Gillette-Guyonnet S, Abellan Van Kon G, Alix E, Andrieu S, Belmin J, Berrut G et al. IANA (International Academy on Nutrition and Aging) Expert Group: weight loss and Alzheimer’s disease. J Nutr Health Aging 2009;13:679-83.

5. Shah RC. Medical foods for Alzheimer’s disease. Drugs Aging 2011;28:421-428.

6. Salva A, Andrieu S, Fernandez E, Schiffrin EJ, Moulin J, Decarti B et al. Health and nutrition promotion program for patients with dementia (NutriAlz): cluster randomized trial. J Nutr Health Aging 2011:15:822-30.

7. Murphy C. Nutrition and sensory perception in the elderly. Crit Rev Food Sci Nutri 1993;33:3-15.

8. Benattar L. Finger food : redonner le plaisir de manger aux personnes âgées atteintes de la maladie d'Alzheimer. Groupe Orpéa 2011.

9. Philip JL. Lutter contre la dénutrition des malades d’Alzheimer, un exemple. Revue Geriatr 2012 ;37 :141-2.

10. White DA, Murphy CF. Working memory for nonverbal auditory information in dementia of the Alzheimer type. Arch Clin Neurospychol 1998;13:339-347.

11. Grégoire J. Prise en charge de la dénutrition en milieu hospitalier : de la théorie à la pratique. Mémoire diététique. Département génie biologique, IUT Montpellier. Avril 2008.

12. Thomas B, Kouyoumdjian C, Duverneuil G et al. L’état bucco-dentaire des persones âgées dépendantes: bilan après 5 ans. Le Chirurgien-Dentiste de France 2011 ;1503 :33-41.

13. Cousson PY, Bessadet M, Nicolas E, Veyrune JL, Lesourd B, Lassauzay C. Nutritional status, dietary intake and oral quality of life in elderly complete denture wearers. Gerodontology 2012;29:e685-92.

14. Hiesmayr M, Schindler K, Pernicka E, Schuh C, Schoeniger-Hekele A, Bauer P et al. Decrease food intake is a risk factor for mortality in hospitalised patients: the Nutrition Day Survey 2006. Clin Nutr 2009;28:484-91.