Health

Addressing the nutritional needs of dementia, Alzheimer’s patients

World Alzheimer’s Month is the international campaign from Alzheimer’s Disease International that takes place every September

Updated 1 year ago · Published on 29 Sep 2022 3:00PM

Addressing the nutritional needs of dementia, Alzheimer’s patients
According to the National Health and Morbidity Survey 2019, 95% of adults in Malaysia did not eat the recommended daily amount of vegetables and fruits. – Pixabay pic, September 29, 2022

IMAGINE waking up one morning not recognising your family members or the people around you and questioning, “who am I, where am I, who are these people?”. 

These symptoms could be one of the important indicators that you have been affected with Alzheimer’s disease or dementia. It is a debilitating disease that takes away the ability to retain memory, think, behave normally and perform everyday activities.

According to the World Health Organisation (WHO), around 50 million people are affected by dementia. Of this, 60% are living in low- and middle-income countries globally with nearly 10 million new cases every year. 

The estimated proportion of the general population aged 60 and above with dementia at a given time is between five and eight per cent. 

In Malaysia alone, the prevalence of dementia was 123,000 people in 2015, and will continue to increase to 261,000 by 2030 and 590,000 people in 2050. 

What is the difference between dementia and Alzheimer’s disease?

Dementia is an overarching terminology used to describe various symptoms of cognitive decline. Whereas Alzheimer’s disease (AD) is the most common form, causing problems with memory loss and difficulties with thinking. 

AD is irreversible and eventually, as it progresses to a more moderate and severe form, it can affect even a simple task and functions ability. The early signs of AD may be forgetting recent events or conversations. There are many different forms of dementia.

Alzheimer's primarily is the common type that contributes to 60% to 70% of cases. 

Other major forms include vascular dementia, dementia with Lewy bodies, and a group of diseases that contribute to frontotemporal dementia. The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.

Vascular dementia is a general term describing problems with reasoning, planning, judgment, memory and other thought processes. One can develop vascular dementia after a stroke blocks an artery in the brain, but strokes do not always cause vascular dementia. Vascular dementia is common in Malaysia. 

There is a general misinterpretation that AD and dementia are two separate diseases. AD is a common form of dementia and there are many contributory factors such as genetics, lifestyle and environment. Having said this, memory loss and cognitive decline can be prevented and even reversed. 

In Malaysia, patients diagnosed with AD are often presented with stroke-related or vascular dementia. Likewise, if diagnosed with Parkinson’s disease, the risk and probability of developing dementia at a later stage may be apparent.

Nutrition and diet for Alzheimer's disease and dementia 

The World Health Organisation recently concluded that many cases of cognitive decline could be delayed or prevented. This can be achieved by getting regular exercise, not smoking, avoiding harmful use of alcohol, eating a healthy diet, and maintaining healthy blood pressure and blood sugar levels. 

Research and studies also indicate a consistent relationship between the development of cognitive impairment and dementia with lifestyle-related risk factors. These include physical inactivity, unhealthy diets, short sleep, night shift work, tobacco use, and the harmful use of alcohol.

Apart from behavioural risk factors, cardiometabolic diseases (CMDs); obesity, hypertension, diabetes, stroke and high cholesterol, as well as depression are also associated with an increased risk of dementia.

Dietary advice and interventions may not be easy for the elderly as not all are very open to dietary and habitual changes.

The elderly can be more regimented to a certain diet (e.g. diabetic or low salt diet advised many years ago) or certain food choices that are “less heaty” or not “cooling” or diet taboos/self-restrictions from the media/alternative therapy or preferences due to religious reasons.

The dietary intervention and advice should address the nutritional needs of the patients. Research has shown that specifically recommended diets can delay the onset of AD. 

According to the National Health and Morbidity Survey 2019, 95% of adults in Malaysia did not eat the recommended daily amount of vegetables and fruits.

Reduced risk/prevention of AD/dementia has been found in studies on the Mediterranean Diet, the DASH Diet, and the more recent MIND diet.

Each of these diets emphasises limiting red meat and focusing on whole grains, fruits, vegetables, fish, nuts/seeds and healthy oils. 

  • The Mediterranean Diet (MD): Most of the research on diet and Alzheimer’s has focused on the Mediterranean diet (MD), an eating pattern that emphasises healthy fats such as olive oil, fresh fruits and vegetables, legumes, nuts, and less dairy food, red meat, butter or margarine, sweetened beverages, and pastries/cakes. 
  • The DASH Diet: The Dietary Approaches to Stop Hypertension (DASH) Diet emphasises many MD components as well as a reduction in overall consumption of carbohydrates and sodium. It has been shown to reduce blood pressure.
  • The MIND Diet: More recently, the Mediterranean-DASH Intervention for Neurodegenerative Delay Diet, known popularly as the MIND Diet, has been shown to slow down cognitive decline. The MIND Diet takes elements of MD and DASH and recommends dietary focus on the “good” foods such as whole grains, green leafy and other vegetables, berries, fish, poultry, beans, nuts, and olive oil while minimising intake of “bad” foods such as red meats, butter, margarine, cheese, fast foods, and sweets/desserts. 

Smoking

Smoking is a clear risk factor for cognitive decline in later years and this risk can be substantially reduced simply by quitting smoking. 

Physical activity

Beyond managing medical diseases, very strong support has been given by some studies to the importance of physical activity in reducing cognitive decline and dementia. 

Influential studies have shown that even mild physical activity decreased the risk of cognitive impairment in later life. The exercise was shown to be most valuable if regular and vigorous.

Recent research suggests that sedentary behavior during young adulthood such as watching at least four hours of TV daily was linked with poorer memory and executive function in mid-life.

Exercising your brain

Cognitive activity, such as more mentally engaging activities like puzzle solving and other brain games, may also be beneficial, though the data are less conclusive about a more specific link to dementia.

Meanwhile, cognitive training involves mental activities such as learning a new sport, hobby, language or skill, or even travel – which all enriches the brain with new sights and sounds. Irrespective of educational background, the brain benefits from lifelong learning.

Advice and tips for AD patients and caregivers 

People with Alzheimer's or dementia do not need a special diet. As with anyone, eating a well-balanced, nutritious diet is important for overall health.

Regular, nutritious meals may become a challenge for people with dementia. As a person's cognitive function declines, he or she may become overwhelmed with too many food choices, forget to eat or have difficulty with eating utensils.

Nutrition tips

Proper nutrition is important to keep the body strong and healthy. For a person with Alzheimer's or dementia, poor nutrition may increase behavioral symptoms and cause weight loss.

As the disease progresses, loss of appetite and weight loss may become concerns. In such cases, a qualified and experienced dietitian may assist in giving practical and nutritional advice for patients and caregivers in meeting their nutritional needs.

Staying hydrated may be a problem as well. Encourage fluids by offering small cups of water or other liquids throughout the day or foods with high water content, such as fruit, soups, milkshakes and smoothies.

Possible causes of poor appetite

  • Not recognising food: The person may no longer recognise the foods you put on his or her plate.
  • Poor-fitting dentures: Eating may be painful, but the person may not be able to tell you this. Make sure dentures fit and visit the dentist regularly.
  • Medications: New medications or a dosage change may affect appetite. If you notice a change, inform the doctor.
  • Not enough exercise: Lack of physical activity will decrease appetite. Encourage simple exercise, such as going for a walk, gardening, etc. 
  • Decreased sense of smell and taste: The person with dementia may not eat because food may not smell or taste as good as it once did.

Minimise eating and nutrition problems

In the middle and late stages of Alzheimer's, swallowing problems can lead to choking and weight loss. Be aware of safety concerns and try these tips:

  • Prepare foods so they aren't hard to chew or swallow. Grind/blend/mash foods, cut them into bite-sized pieces or serve soft foods (applesauce, cottage cheese, scrambled eggs).
  • Be alert for signs of choking. Avoid foods that are difficult to chew thoroughly, like raw carrots. Encourage the person to sit up straight with his or her head slightly forward. At the end of the meal, check the person's mouth to make sure food has been swallowed. 
  • Address a decreased appetite. If the person has a decreased appetite, try preparing favorite foods, increasing physical activity, or plan for several small meals rather than three large ones. If the person's appetite does not increase and/or he or she is losing weight, consult a doctor. 
  • Only use vitamin/mineral supplements on the recommendation of a qualified experienced physician/dietitian. – The Vibes, September 29, 2022


Rozanna M Rosly is a clinical dietitian at Global Doctors Hospital

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