From the Guidelines
Weight loss in people with dementia should be addressed promptly by consulting a healthcare provider and implementing a multidisciplinary approach to manage nutrition and hydration, as recommended by the most recent ESPEN guideline on nutrition and hydration in dementia - update 2024 1.
Key Considerations
- Weight loss is a common feature of dementia, occurring in nearly half of patients with mild to moderate forms of Alzheimer's disease 1
- The mechanisms underlying weight loss in dementia are complex and multifactorial, involving neurodegenerative processes, genetic factors, and inflammatory processes 1
- Regular weight monitoring is essential to track changes and adjust interventions accordingly, with a recommendation to monitor body weight routinely and document it in every person with dementia 1
Management of Weight Loss
- Establish regular meal times in a calm environment with minimal distractions
- Offer nutrient-dense foods that are easy to eat, such as soft foods or finger foods
- Provide visual cues and gentle reminders during mealtimes
- Consider nutritional supplements like Ensure, Boost, or Carnation Instant Breakfast between meals if recommended by a healthcare provider
- Monitor fluid intake to prevent dehydration
Importance of Multidisciplinary Approach
- A multidisciplinary approach involving caregivers, dietitians, and healthcare providers offers the best chance of maintaining adequate nutrition and preventing further weight loss
- This approach should include regular screening for malnutrition, assessment of nutritional status, and individualized interventions to reduce the risk and treat malnutrition and/or dehydration 1
Frequency of Weight Monitoring
- The frequency of weight monitoring may vary depending on general health and nutritional status, but it is recommended to weigh at least every 3 months and at least monthly if nutritional, health, or weight problems arise 1
From the Research
Weight Loss and Dementia
- Weight loss is a common issue in patients with dementia, and it is associated with cognitive impairment and poorer disease outcomes 2.
- Studies have shown that providing nutritional complete oral nutritional supplements (ONS) drinks can have a positive effect on weight gain and cognition in older people with dementia 3.
- However, some dementia medications may be associated with reported body weight or body mass index loss, highlighting the need to consider the potential impact of pharmacotherapy on weight loss in patients with dementia 2.
Nutrition and Dementia
- There is extensive evidence supporting a relationship between diet and cognitive functions, and vitamin supplements may be a solution to nutritional deficiencies and the prevention of dementia and mild cognitive impairment 4.
- Folic acid supplementation has been shown to have better outcomes on cognitive tests than control groups, and combined supplementation of folic acid and vitamin B12 may also have a positive effect on cognitive performance 4.
- However, the results of vitamin D supplementation trials are not conclusive in assessing the potential benefits that vitamin D might have on cognition 4.
Energy Intake and Expenditure
- Current available literature does not support the view that there is a lower energy intake and/or a higher energy expenditure in older people with dementia when compared to those without dementia 5.
- Understanding the cause of energy imbalance in older people with dementia is crucial to develop targeted interventions to avoid detrimental health effects in this vulnerable group 5.
Interventions to Increase Oral Intake
- Megestrol acetate, an oral liquid suspension, has been shown to increase oral food and fluid intake in nursing home residents when combined with optimal mealtime feeding assistance 6.
- However, megestrol acetate was not effective in increasing oral intake under usual nursing home care conditions, highlighting the importance of adequate feeding assistance 6.