From the Guidelines
Cognitive decline accompanied by loss of appetite requires prompt medical evaluation and intervention to prevent malnutrition and its serious consequences, as recommended by the most recent ESPEN guideline on nutrition and hydration in dementia - update 2024 1.
Key Recommendations
- Screening for malnutrition should be performed in all persons with dementia, and repeated at regular intervals, such as every 3-6 months, or more frequently if changes in general health, eating ability, or eating behavior occur 1.
- Ensure adequate nutrition through small, frequent, nutrient-dense meals, maintain hydration, and establish a regular eating schedule.
- For cognitive support, maintain social engagement, engage in mental stimulation activities, and follow a regular sleep schedule.
- Medications that might be prescribed include cholinesterase inhibitors for cognitive symptoms if dementia is diagnosed, or mirtazapine which can help with both depression and appetite stimulation.
- The use of appetite stimulants, such as megestrol acetate, should not be systematic, but rather considered on a case-by-case basis, as recommended by the ESPEN guidelines 1.
Monitoring and Assessment
- Regular monitoring of weight, food intake, and cognitive function is essential to track progress and adjust treatment as needed.
- Close monitoring and documentation of body weight in every person with dementia is recommended, with weighing at least every 3 months, or more frequently if nutritional, health, or weight problems arise 1.
- Assessment of specific eating problems and behavioral symptoms, such as using the Edinburgh Feeding Evaluation in Dementia Questionnaire (EdFED-Q) or the Eating Behavior Scale (EBS), can help identify individual needs and guide interventions.
Nutrition and Hydration
- Provision of meals in a pleasant, homelike atmosphere, and provision of adequate food according to individual needs, with respect to personal preferences, are recommended 1.
- Encouraging adequate food intake, and providing adequate support, are also essential 1.
- Artificial nutrition and hydration should be considered on an individual basis, with respect to general prognosis and patients' preferences 1.
From the Research
Cognitive Decline and Loss of Appetite
- Cognitive decline is a natural process that occurs in all individuals during the aging process, and it can result in mild cognitive impairment and dementia 2.
- There are more than 100 causes of dementia, and a multifocal approach to slowing cognitive decline, including the Mediterranean diet, exercise, and socialization, appears to be effective 2.
- Selective serotonin reuptake inhibitors (SSRIs) have been studied for their potential cognitive-enhancing effects in patients with Alzheimer's disease, but the evidence is limited and inconclusive 3, 4, 5.
- A novel screening scale has been developed to assess appetite loss in older adults with and without cognitive impairment, which may be useful in identifying individuals at risk of malnutrition 6.
Relationship Between Cognitive Decline and Loss of Appetite
- Cognitive impairment can lead to alterations in eating behavior, including changes in appetite, and people with dementia may experience difficulty expressing their dietary needs and preferences 6.
- The loss of appetite in older adults with cognitive impairment can have significant consequences for their nutritional status and overall health 6.
- Further research is needed to fully understand the relationship between cognitive decline and loss of appetite, and to develop effective interventions to address these issues 2, 6.
Treatment Options
- SSRIs may have some cognitive-enhancing effects in patients with depression, but the evidence is limited and more research is needed to fully understand their potential benefits 3, 4, 5.
- A multifocal approach to slowing cognitive decline, including lifestyle modifications and socialization, may be effective in reducing the risk of dementia and improving overall health 2.
- The novel appetite loss screening scale may be a useful tool in identifying individuals at risk of malnutrition and in developing targeted interventions to address appetite loss in older adults with cognitive impairment 6.