Nutrition and Alzheimer’s Disease (AD

)
“What caregivers need to know”

W hy

is nutrition important for people with AD?

Proper nutrition is important to both healthy people and people with AD. Although nutrition may have little effect on the progression of AD, adequate energy and nutrient intake will ensure a better quality of life, reduce the chances of infections, falls and fractures, as well as promote good wound healing.

What

are the implications of AD on nutrition?

Although the patterns of symptom progression are classified into seven stages, the rate of progression and symptoms varied between individuals with AD. During the early stages of AD progression, one may:  simply forget to eat or forget having eaten  have difficulty in shopping, cooking or storing food  suffer from depression, hence leading to loss of appetite  have increasing preference for sweets and strong tasting foods (e.g. salty and spicy foods) As AD progresses, one may:  forget to chew / swallow food  overeat / eat inappropriate foods (e.g. eating anything in sight) / be unable to distinguish food from the plate or bowl  have higher energy requirements as a result of pacing and agitation  loss the ability to self-feed During the last stage of AD, one may:  loss muscular control in the mouth  have impaired hunger and appetite regulation  have impaired swallowing abilities  not recognize food

Ho w
Dental problems

to deal with the nutritional challenges of AD?

During the earlier stages of AD when symptoms do not hinder eating abilities, having a diet with accordance to the Healthy Diet Pyramid will ensure adequate nutrition. However adequate nutritional intake proves to be a challenge when symptoms of AD progresses. When faced with eating problems, care givers should check the following:

Presence of any co-existing disease

Medications that may impair appetite

Distracting environment

Food quality

Chewing and swallowing ability

 Ill fitting dentures can make eating painful. Make sure dentures fit properly and regularly look out for mouth sores  Ensure regular dental check-up  Uncontrolled diabetes: May cause loss of appetite.  Intestinal problems: Diarrhoea, constipation and heartburn may cause loss of appetite  Cardiovascular and/or pulmonary diseases: May cause shortness of breath and consequently loss of appetite  Consult a Doctor and Dietitian to help manage the co-existing disease  Some medications (e.g. antibiotics, heart medication, antidepressant and arthritis medication) can impair appetite  Check with your Doctor / Pharmacist for substitution  Distraction during mealtime may affect appetite  Minimize distraction by:  Turning off the telephone ringer, television and radio  Using non-patterned, solid coloured plates & bowls to reduce confusion between food and the former  Keeping the table setting simple i.e., remove all centerpieces, only provide the utensils needed and only use non-patterned table cloths  Serving only one food at a time (e.g. porridge followed by cooked meat)  Avoiding multi-texture food (e.g. jelly with fruit pieces, minestrone soup)  Is the food too hot / cold?  Is there a change in food preference?  Is the food appearing  Provide bite-size pieces of foods, minced or blended foods  Avoid nuts, popcorn and raw carrots which are harder to chew and swallow  Contact a your Doctor to seek referral to a Speech Therapist to determine the most appropriate texture of food and thickness of fluids to prevent choking. You may also be referred to a Dietitian to ensure adequate nutrition when on modified texture diet

Emotions

 Depression can lead to loss of appetite. Seek medical help  Give encouragement, dignity and independence  Avoid criticisms on eating habits  Give ample time to eat as well as reminder to chew and swallow  Provide opportunity to have meals with other family members  Provide adaptive equipments such as special spoons  Don’t force feed

Some other tips to boost nutrition:  Serve several small meals rather then three large ones  Serve finger food such as baked chicken nuggets, baked fish sticks, cut boiled eggs as well as soft vegetables like broccoli, cauliflower and baked pumpkin.  Increase physical activities (e.g. strolling in parks, climbing the stairs, playing instruments, washing dishes or doing laundry) as tolerated to increase appetite  Allow participate in some appropriate phase of food making (e.g. biting of eggs, washing food, mixing food)  Appetite and alertness is best in the morning, so serve more food during breakfast  Provide high-protein, high-calorie snacks (e.g. scramble eggs, yoghurt, beancurd, quarter sandwich, red/green bean soup, milk shakes) between meals  If appetite remains poor, provide nutritional supplements such as Ensure Plus. Resource Plus and Enercal Plus between meals or as meal replacements. Contact a Dietitian to determine the appropriate amount to be given.

W he n

do I need to seek help?

1. Swallowing impairment: If you notice the symptoms below, please contact your Doctor to seek referral to a Speech Therapist for a detailed swallowing assessment.  "Gurgly" sounding voice after eating  Coughing during or after swallowing  Inability to control food or saliva in the mouth 2. Significant weight loss: Please seek medical attention if more than 5% or 10% of involuntary weight loss occurred within one month or six months respectively.

Where
  

to seek nutritional help?

Polyclinics Restructured and Private Hospitals Singapore Nutrition and Dietetic Association

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