The Sensory Nervous System And Alzheimers Disease
Alzheimers disease changes the brain in many ways and interferes with the complex systems that regulate the human sensory system, including vision, hearing, somatic sensation , taste and olfaction .
In the person with Alzheimers disease, molecular and cellular changes in the brain block essential brain neurons and damage their synaptic connections. According to The National Institute on Aging, these neurons are essential to healthy brain function and a major factor in the central nervous system.
The result? Feelings associated with hunger are no longer interpreted by the brain the same way they were in the healthy brain. Each of the five sensessight, hearing, smell, taste and sense of touchare dramatically affected in the person with dementia and Alzheimers disease.
Those affected may not realize that theyre feeling agitated or sleepy due to low blood sugar or skipped meals. They may not recognize the smell of a favorite food. They may not be able to hold a fork or a spoon. Or they may not even see the food on the plate well enough to eat it.
Besides The Presence Of Other Health Problems And Medication Side Effects Are There Other Reasons Persons With Alzheimers Disease Lose Weight
Other reasons for weight loss in persons with Alzheimers disease include:
- More calories being burned. Individuals with Alzheimers disease may lose weight because they may burn more calories than elderly people without the disease. People with dementia frequently pace, wander, and are more likely to be in motion activities that burn more calories.
- The effects of Alzheimers disease itself and aging. Food preferences may change as dementia progresses. Favorite foods may no longer be favorites. Certain food types may become more desired . Vision or sense of smell or taste may become impaired, which makes finding the food and stimulating the appetite more difficult. If the individual with Alzheimers disease is delusional, they may not eat because they fear something, hear voices, or may be distracted during dining and leave the table before finishing the meal. People with advanced Alzheimers disease may lose the ability to recognize foods or forget how to use utensils to bring food into the mouth even though they may be hungry. They can also forget how to chew and swallow food. In addition, patients can also lose weight if they can no longer communicate health problems that are making it less desirable to eat, such as gastrointestinal pain and discomfort.
Other events in the lives of the elderly, such as grief and mourning the loss of a spouse or life-long friends as well as social isolation, can also lead to weight loss.
Weight Loss And Eating In The Later Stages Of Dementia
Many people with dementia lose weight in the later stages. This may be because of a loss of appetite, pain or difficulties with swallowing and chewing. People with swallowing problems are at risk of choking and of food or saliva going down the windpipe, causing an infection.
Weight loss can affect the immune system and make it harder for the person to fight infections and other illnesses. It can also increase the risk of falling and make it harder for the person to remain independent.
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Factors Contributing To Brain Health
There are many factors contributing to dementia and cognitive decline, with lifestyle, genetics, and diet all playing a role.
Dana Ellis Hunnes, PhD, MPH, RD, clinical dietitian at UCLA Medical Center, adjunct professor at UCLAs Fielding School of Public Health, and author of Recipe For Survival, said the Mediterranean diet may possibly reduce dementia risk due to its high levels of antioxidants and anti-inflammatory compounds that are naturally occurring in plant-based foods, healthy monounsaturated fats, whole grains, nuts, and seeds.
But most evidence on the effectiveness of the Mediterranean diet on brain health is derived from observational studies, said nutrition expert Keith-Thomas Ayoob, EdD, RD, associate clinical professor emeritus of pediatrics at the Albert Einstein College of Medicine in New York City.
There are clinical trials, like the PREDIMED study, that actually give people extra virgin olive oil and nuts to eat daily that show benefits for cardiovascular health and reduced risk of other conditions, such as type 2 diabetes and hypertension, Ayoob told Healthline.
Its hard to do this type of clinical study though for dementia, as it takes so long and measuring compliance in free-living populations is always iffy.
Nutrition For The Elderly
The nutritional needs of older adults decrease with age. An 80 year old needs 20 percent fewer calories per day than a 30 year old because of changes in lifestyle and overall slowing of metabolism. Even if your loved one has a healthy appetite, the process of aging can by nature cause nutrient deficiencies and changes in appetite. Some of the changes associated with aging that can have an effect on nutrition include reduced sense of smell, decreased sense of thirst, eating alone and difficulty chewing foods.
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When Is Your Dementia Patient Ready For Hospice Care
Alzheimer’s disease and other progressive dementias are life-altering and eventually fatal conditions for which curative therapy is not available. Patients with dementia or Alzheimers are eligible for hospice care when they show all of the following characteristics:1
- Unable to ambulate without assistance
- Unable to dress without assistance
- Unable to bathe properly
- Incontinence of bowel and bladder
- Unable to speak or communicate meaningfully
Thinking of dementia as a terminal illness from which patients will decline over a matter of years, rather than months, allows healthcare professionals to focus explicitly and aggressively on a palliative care plan.2
Mouth Chewing And Swallowing Problems In Dementia
Some problems with eating may relate to the physical condition of the mouth. A dry mouth or mouth discomfort from gum disease or ill-fitting dentures are common problems.
Things that might help to improve the condition of the mouth include:
- Arrange a dental check-up of gums, teeth and dentures.
- Moisten food with gravies and sauces if a dry mouth is causing problems.
- For chewing problems, try light pressure on the lips or under the chin, tell the person when to chew, demonstrate chewing, moisten foods or offer small bites one at a time.
- For swallowing problems, remind the person to swallow with each bite, stroke the throat gently, check the mouth to see if food has been swallowed do not give foods that are hard to swallow, instead offer smaller bites and moisten food.
- Consult their doctor if choking problems develop.
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Helping A Person With Dementia Who Is Not Eating Or Drinking
The person should be supported to eat and drink for as long as they show an interest and can do so safely . There are ways to help make this easier for the person. For example:
- choosing a plate that is a different colour to the food
- giving the person enough time
- putting the drink in their hand if they are struggling to see it.
Eating and drinking can still bring the person pleasure, even in the later stages. Many peoples tastes will change as they get older and as dementia progresses .
Think about the persons oral health as this will have an impact on their ability to eat and communicate . If the person has poor oral health it may lead to pain, which could mean they dont want to eat or they behave in ways that are out of character.
Swallowing and chewing problems can be distressing for the person and those supporting them. If the person is having difficulties, its important to speak to the GP they may refer the person to a speech and language therapist or nutritional specialist.
Dementia Connect support lineDementia Connect support line.
What Can You Do About Weight Loss Associated With Pd
If you do find yourself unable to maintain a healthy weight, discuss this with your doctor. The good news is that after a medical workup, he or she may suggest one or more of the following steps that can help you:
Tips and takeaways
- Despite a diagnosis of PD, weight loss should prompt a full medical workup.
- Weight loss that is attributed to PD can be caused by a variety of reasons including decreased appetite, increased energy expenditure, swallowing difficulties, and poor gut motility.
- Weight loss has been linked to a poorer quality of life in PD and may contribute to increasing frailty.
- There are steps you can take that may help. Depending on the causes contributing to weight loss, efforts to counteract weight loss could include consultation with a dietician, swallow evaluation and PD medication adjustment.
- As with all symptoms, discuss your concerns about weight loss with your doctor.
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How Are Patients With Alzheimers Disease Who Are Losing Weight Evaluated
The doctor will gather the patients medical history and conduct a physical exam to look for the medical issues that often underlie the cause of the weight loss and need treatment. Many doctors review a patients medications as the first step since they are often the cause of loss of appetite and weight. All current prescription and over-the-counter medications and supplements should be reviewed.
A speech pathologist may be consulted to determine if the patient has any swallowing problems.
Severe Dementia Predicts Weight Loss By The Time Of Death
- 1Discipline of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- 2Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil
- 3Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
- 4Department of Neurology and Pathology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
Background: Body mass index in midlife is associated with dementia. However, the association between BMI and late-life obesity is controversial. Few studies have investigated the association between BMI and cognitive performance near the time of death using data from autopsy examination. We aimed to investigate the association between BMI and dementia in deceased individuals who underwent a full-body autopsy examination.
Methods: Weight and height were measured before the autopsy exam. Cognitive function before death was investigated using the Clinical Dementia Rating scale. The cross-sectional association between BMI and dementia was investigated using linear regression models adjusted for sociodemographic and clinical variables.
Results: We included 1,090 individuals . Most participants had a normal BMI , and the prevalence of dementia was 16%. Twenty-four percent of the sample had cancer, including 76 cases diagnosed only by the autopsy examination. Moderate and severe dementia were associated with lower BMI compared with participants with normal cognition in fully adjusted models .
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Are There Certain Medications That An Elderly Person Or Person With Alzheimers Disease May Be Taking That Are Known To Cause Weight Loss
Weight loss is a side effect of many medications that an elderly person or person with Alzheimers disease may take. The types of medications include:
- Cardiac drugs. Including drugs to treat cholesterol heart failure, high blood pressure , chest pain , and drugs to reduce fluid buildup
- Neurologics and psychotics. Including drugs used to treat depression, anxiety, seizures, bipolar disorder, schizophrenia, Parkinsons disease and Alzheimers disease
- Bone and joint and pain drugs. Including drugs to treat osteoporosis, arthritis, gout, pain , and lupus
- Endocrine drugs. Including drugs to treat thyroid disease and diabetes
- Others. Including aspirin, some antibiotics, cold products, allergy products, iron, potassium, alcohol and nicotine, drugs used to treat involuntary muscle movement
Changes Of Eating Behavior In Dementia
Dementia is an age-associated syndrome due to several disorders affecting the central nervous system. Neurodegenerative dementia occurs mainly in people older than 65 years and is characterized by progressive cognitive impairment with consequence on multiple aspects of daily living leading to loss in daily functioning and behavior disturbances. The most common form of dementia worldwide is Alzheimer disease while frontotemporal dementia is a common cause of early-onset dementia . Non-cognitive, behavioral and psychiatric disturbances like apathy, disinhibition, agitation, depression, psychosis, appetite changes and sleep disturbances are key aspects normally assessed for the diagnosis of dementia . During the course of the disease, patients can present peculiar dietary changes and eating disorders, especially in the initial and intermediate stages. Instead, in the final stages of the disease, with a marked impairment of functional and cognitive ability and a complete dependency from others, we can find an overlap of the symptoms with main difficulties related to feeding themselves and swallowing . In the Neuropsychiatric Inventory , the main tool used to assess behavior disturbances in dementia, dietary changes or other eating behaviors are investigated due to their important clinical role in the course of the disease . However, this general assessment is often insufficient, given the complexity and diversity of eating disorders in dementia.
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Weight Loss And Dementia
There are many reasons why weight loss occurs in people with Alzheimers disease and dementiasome even scientists dont fully understand.
About 40% of all people with dementia experience significant weight loss. Despite popular belief, its not all about memory and nutrition. Physiology plays an important role, and in the case of Alzheimers disease, brain cells.
Both Alzheimers and dementia are progressive diseases, and because the brain regulates hunger through a complex system of hormones and chemicals, ones appetite and tastes change as the disease progressives.
In the person with dementia, the sense of taste often diminishes over time. Favorite foods may no longer be appealing. Vision may become impaired, making is more difficult to locate food on the plate. Fine motor skills decline, making the physical act of eating more challenging. Sense of smell wanes, reducing the effects of sweet and savory aroma molecules on the appetite.
Many people with dementia lack appetite or the ability to interpret hunger. In later stages, they may struggle to chew or lack the motor skills required to hold utensils.
All of these add up to a dangerous weight loss spiral in the person with dementia and Alzheimers disease.
Dementia & Alzheimer’s Disease
Due to our close experience with dementia and weight loss, we found it essential to conduct this extensive article.
People who have dementia may, at one point in the illness, may deal with weight loss at the same time.
This especially happens in the later stages of the disease.
This can be very heartbreaking, due to the fact that food is a very crucial part of a persons existence and health.
Below we talk about weight loss in people who have dementia.
We mention causes, negative effects, and how to manage this distressing condition.
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Support For Families And Carers
Carers should make sure their own diet is varied, nutritious and enjoyable.
Dealing with a range of issues can be difficult for some people with dementia and their families and carers. If you would like further assistance or to speak to someone personally about your particular situation, call the National Dementia Helpline, a national telephone advisory service established to support carers.
Eating And Drinking For A Person With Dementia
Dementia often has an impact on peoples appetite and ability to eat and drink. Read our advice on some of the changes you might notice and how to support the person you care for.
People with dementia may experience problems with eating and drinking, and its quite common for their appetite to change as their condition progresses.
They might:
- forget to eat or drink
- not recognise when they are hungry, thirsty or full
- have trouble preparing food or drinks
- struggle to recognise food items
- have a change in appetite or taste
- find certain colours, textures or smells of food off-putting
- struggle to follow particular diets, for example for diabetes, coeliac disease, or religious or cultural diets
- have difficulty handling cutlery and feeding themselves
- find it difficult to swallow
- develop a sweet tooth
Helping a person with dementia to maintain a healthy diet can be difficult, but its important to encourage them to eat well. You could try:
A person with dementia may not always be able to recognise when they are thirsty, or communicate their thirst. This means it can be difficult for them to drink the recommended eight to 10 glasses or mugs of fluid per day. You could try:
- making sure the person always has a drink beside them
- offering squash if they dislike water
- offering a choice of hot and cold drinks
- helping if they are struggling to pick up or hold a cup
- offering different shapes and sizes of cup
- using a favourite mug, glass or cup, if they have one
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Why Do People With Dementia Lose Weight
While there are many contributing factors, the cognitive and behavioral changes, hormone dysregulation and sensory dysfunction in the body and brain all converge to disrupt appetite, leading to weight loss in people with dementia.
Various reasons for weight loss in people with Alzheimers disease and dementia include:
The cascading effect of progressive brain disease can alter the nervous and endocrine systems as well as other essential functions of the body, including those that impact taste and other senses.
How To Help Doctors Monitor Weight Loss And Malnutrition
In addition to performing a physical examination of the patient, doctors may ask the caregiver for a detailed history of the patients eating habits and weight.
Dr. Fabius recommends his patients weigh themselves twice weekly, with assistance from caregivers or family members if necessary. He also suggests keeping a food diary, which will help paint an accurate picture of a persons caloric intake and the timing of the weight loss.
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