Once a patient is suspected of having Alzheimer’s disease, comprehensive physical, radiological, and neuropsychological examinations will likely be performed by the attending physician. A full nutritional assessment may also be warranted at this time. Since Alzheimer’s disease is a slow, progressive illness, many patients will at first appear in excellent physical health. Severe dementia brought on by nutritional imbalances or deficiencies is rare, but some instances of mental impairment among persons over the age of sixty have been associated with lower-than-average vitamin intake or an inability to utilize certain vitamins. A physical examination and nutritional assessment will likely exclude the possibility that the dementia has a dietary origin.
The gradual mental decline usually associated with Alzheimer’s disease is typically accompanied by physical decline of the patient. Such decline is the combined result of neuromuscular impairment, a reduction in ability to exercise, and inadequate nutritional intake. Confusion, gradual loss of short-term recall, and a shortened attention span may result in the Alzheimer patient not completing or even skipping meals. Selecting the proper eating utensil may become a difficult and frustrating mental task. The caregiver will eventually have to make what appear to be simple decisions for the Alzheimer patient.
Meals skipped, excessive irritability, and reduced sleeping hours over extended periods of time may place the Alzheimer patient in a continual negative calorie condition. Under such eating conditions, protein-calorie malnutrition may occur, and the patient will begin to lose weight. It seems reasonable, therefore, that attention to the patient’s weight and caloric intake are the first defenses that a family can take against the physical deterioration associated with Alzheimer’s disease.
Reduced caloric intake and weight loss lead to reductions in both vitamin and mineral intake, even if smaller amounts of a balanced diet are eaten by the patient. Protein-calorie malnutrition hastens vitamin/mineral deficiencies unless a vitamin/mineral supplement is provided. However, there are no data suggesting that vitamin/mineral supplements either retard or accelerate the course of Alzheimer’s disease. Caregivers should consult with the attending physician concerning use of a vitamin/mineral supplement.
Protein-calorie malnutrition is frequently encountered in elderly patients in hospitals and other institutional settings as a condition secondary to the primary disease. Inadequate food intake frequently arises from mental decline, loss of physical dexterity, difficulty in swallowing, and the need to be spoon-fed by a caregiver. Without necessary caloric intake, vitamin/mineral deficiency can lead to impairment
of the immune system or the blood. The immune system is responsible for combating infectious disease, including pneumonia, which occurs frequently in Alzheimer’s patients. Impairment of the blood system may result in anemia, thereby further weakening the patient.
During the advanced stages of Alzheimer’s disease, the patient’s family may be confronted with the decision to provide nutritional support therapy by nasogastric tube or total parenteral nutrition (TPN), administered through a tube into the esophagus or stomach. Such decisions, often difficult to make, usually reside with family members after consultation with the attending physician.
Protein-calorie malnutrition associated with vitamin/mineral deficiencies and dehydration are frequent consequences of Alzheimer’s disease. Vitamin-mineral deficiencies are readily preventable through the course of the disease by providing solid or liquid supplements. Dehydration can be prevented by noting sufficient consumption of liquids. Protein-calorie malnutrition is more difficult to prevent. Increased family awareness of nutritional aspects, professional assistance, and more attention to the nutritional management of the Alzheimer patient may slow the rate of mental and physical decline of the Alzheimer patient.