Dementia and Weight Loss: Uncover the Shocking Causes and Effective Solutions

Dementia is an umbrella term for a range of conditions that impair a person's memory, thinking, and behavior. Alzheimer's disease is the most well-known of these illnesses. While dementia is more frequent in older persons, it can strike at any age. Weight loss is a frequent and concerning symptom in people with dementia, particularly in the later stages. Understanding the reasons for this weight loss and how to manage it is critical for caregivers and healthcare professionals. Unintentional weight loss is a prominent clinical feature in some individuals with dementia

Dementia and Weight Loss: The Connection

Dementia can cause unintentional weight loss. Not consuming adequate calories or liquids can also lead to other complications, like dehydration and chronic infections. About 40% of all people with dementia experience significant weight loss. Dementia doesn’t just affect memory. It can also affect physical health in surprising ways. Understanding how dementia affects appetite and well-being is the first step towards helping.

Why Do People with Dementia Lose Weight?

There are numerous reasons why people with dementia experience weight loss. These can be broadly categorized into cognitive and behavioral changes, physiological factors, and external influences.

Cognitive and Behavioral Changes

Loss of Appetite: People with dementia may not be hungry or may forget to eat. They may also lose the ability to communicate when hungry or thirsty. As dementia progresses, it can change a person’s relationship with food and their ability to eat, which can lead to weight loss. Food preferences may change, and favorite foods may no longer hold interest.
Memory Issues: People with dementia may have trouble grocery shopping, cooking meals, or recognizing foods. They may depend on others to prepare food and set a meal schedule. Neurological symptoms such as memory loss and confusion occur when communication networks in the brain are damaged or destroyed. For this reason, people with dementia often forget to eat and drink or recognize the food on the plate.
Distraction: A person’s environment can distract them from eating. Distractions can include dim lighting, colorful dinnerware or decor, glasses and utensils, and too much activity around mealtimes. Easily overwhelmed and frustrated due to changes in the brain, common dementia symptoms can prevent people from getting proper nutrition while demanding larger amounts of energy.
Changes in Taste and Smell: In the person with dementia, the sense of taste often diminishes over time. Favorite foods may no longer be appealing. Sense of smell wanes, reducing the effects of sweet and savory aroma molecules on the appetite. Sensory changes such as deterioration of the olfactory bulb and/or diminished gustatory perception can contribute to weight loss as a result of cholinergic deficits.
Difficulty with Recognition: In later stages of Alzheimer’s disease, people may no longer recognize foods. And they can forget how to use utensils to bring food to their mouth.

Physiological Factors

Issues with Chewing and Swallowing: "Dysphagia" is the term for trouble swallowing. Up to 57% of people with advanced dementia have issues with chewing and swallowing. This may lead to weight loss, malnutrition, or dehydration.
Underlying Health Issues: Coexisting medical conditions such as depression, diabetes, thyroid disease, constipation, cancer, dysphagia, heart and kidney disease and even dental issues can cause weight loss.
Hormone Dysregulation: When the body needs nourishment, neurotransmitters are released, sending messages to the brain that signal hunger and stimulate appetite. When brain cells are compromised by dementia, the chemicals and hormones of the hypothalamic system are disrupted. Neuroendocrine dysregulation in dementia may also give rise to BW loss. Because the biggest component of BW or BMI loss is loss of adipose tissue , discussion of adipose as the largest endocrine organ in the body deserves attention. Adipose tissue secretes hundreds of cytokines, peptides, and hormones, collectively referred to as adipokines, which interact with the brain to control energy metabolism and other brain functions.
Sensory Dysfunction: Changes in visual and spatial abilities and diminished gustatory perception (taste) discourage eating. Food on the plate may be difficult to see or smell differently. The Sensory Nervous System and Alzheimer’s Disease Alzheimer’s disease changes the brain in many ways and interferes with the complex systems that regulate the human sensory system, including vision, hearing, somatic sensation (touch), taste and olfaction (smell). In the person with Alzheimer’s disease, molecular and cellular changes in the brain block essential brain neurons (nerve cells) 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 senses-sight, hearing, smell, taste and sense of touch-are dramatically affected in the person with dementia and Alzheimer’s disease. Those affected may not realize that they’re 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.
Medications: The side effect of medications used to ease the symptoms of dementia and Alzheimer’s disease may cause unwanted weight loss. Unintentional weight loss may be a side effect of medication used to treat Alzheimer’s disease.
Hypermetabolism: Hypermetabolism, defined as an elevated basal metabolic rate of >10% [in energy (e.g., kJ) per unit time], is suggested to cause BW loss. Studies in patients with AD show increased , but also reduced and no change in energy metabolism.

External Influences

Dentures That Don’t Fit: Ill-fitting dentures can make eating painful and difficult, leading to reduced food intake.
Lack of Exercise: Lack of exercise can reduce appetite and contribute to muscle loss.
Embarrassment from Trouble with Eating: People with dementia may feel embarrassed or ashamed if they have difficulty eating, leading them to avoid meals.
Social factors: Social differences The link between approaching dementia and losing weight was made using the unusually extensive medical records held at the Mayo Clinic as part of the Rochester Epidemiology Project, set up over 40 years ago to provide accurate data for almost any serious medical condition. The gender difference might be social, says Knopman. In the population he studied, he says, it could be that men were more likely to have meals cooked for them, making forgetting, or not bothering, to make meals less of a problem.

The Role of Obesity

Obesity between the ages of 35-65 can increase dementia risk in later-life by about 30%. This is from an analysis that combined 19 different long-term research studies. The same analysis also showed that being overweight but not obese, didn’t carry the same risk. Other studies have shown similar results. Obesity is also linked to other dementia risk factors. People with obesity are two to three times more likely to have high blood pressure and type 2 diabetes.

The increased brain shrinkage associated with obesity has been suggested by some to age the brain by around 10 years. Research has shown also that the areas of the brain that start to shrink more in Alzheimer’s disease also shrink in people who are obese. Obesity can also lower a person’s resilience to the damage in the brain that Alzheimer’s disease causes, leading to worse symptoms and faster disease progression. Obesity can also lead to chronic inflammation in the body, which can have knock-on effects on the brain. Inflammation in the brain is linked to dementia as it can cause the over-activation of immune cells in the brain which leads them to damage the brain’s nerve cells.

Identifying Weight Loss and Eating Issues

Weight loss of 5% of body weight over 6-12 months warrants investigation. Signs a person is having trouble during meals may include misusing utensils and dinnerware, such as using a knife for dessert and pouring a glass of water into a cereal bowl. Choking or gagging may be signs of swallowing issues.

What Behavior Signs Should I Look Out For?

Signs a person is having trouble during meals may include misusing utensils and dinnerware, such as using a knife for dessert and pouring a glass of water into a cereal bowl. Choking or gagging may be signs of swallowing issues.

Can Dementia Cause Other Eating Issues?

Some people with dementia may crave sweet foods or overeat. How the disease affects a person’s appetite is individual.

Managing Weight Loss in Dementia

Before treatment, it’s important to determine whether the weight loss is directly related to dementia or some other health issue. Treating the underlying issues may help. If your loved one with Alzheimer’s disease is losing weight, check with their healthcare provider to get to the bottom of it. There are a lot of variables that can lead to weight loss, so the provider should be taking a very thorough look at what’s going on.

Modifying Meal Habits and Environment

Changing certain habits can help with forgetting to eat or other distractions. For example, you can:

Read also: Ketogenic Diet for Dementia

Serve food one course or item at a time.
Remove distractions from the environment (table decor, noise, activity, etc.).
Offer finger foods.
Offer familiar or favorite foods.
Serve soft foods to people with swallowing issues.
Eat with the person.
Offer plenty of fluids to prevent dehydration.
Set aside dedicated mealtimes.
Encourage daily exercise to stimulate appetite.
Domestic kitchens and dining rooms to minimize stimulation. Large dining rooms have been linked to reduced food intake and weight loss.
Colorful dishware and placemats to create color contrast and help food stand out on the plate
Smaller food portions to reduce anxiety caused by a crowded plate.
Offer favorite foods and choices to appeal to changing preferences.
Offer frequent snacks and lots of choices to increase feeding opportunities and nutritional intake.
Aromatherapy, including use of essential oils and scented washcloths to engage the sense of smell.
Family-style meal prep which serve food out of pots to stimulate appetite and get the gastric juices flowing.
Serve warm foods. Waiting for food to cool might be a deterrent to eating.
Limit utensils to one or service meals in a mug to minimize frustration caused by loss of motor skills.
Chop food into smaller bites or serve one food at a time and offer finger foods to help coordination challenges.
Play calming music during mealtime to minimize any anxiety and frustration caused by eating difficulties.
Reduce and remove distractions such as TV and radio.

Dietary Strategies

Nutrient-Dense Foods: Start with nutrient-dense foods like fruits, vegetables, whole grains, lean proteins, and healthy fats. Try to help your loved one cut back on saturated fats, excess salt, and cholesterol.
Frequent Small Meals: Frequent, smaller meals can help meet nutritional needs without overwhelming someone with dementia.
High-Calorie Snacks: High-calorie snacks like nuts, cheese, yogurt, and avocado are excellent options.
Higher calorie food choices to help maintain weight.
Offer soft foods such as applesauce, cottage cheese, yogurt and pudding to mitigate chewing and swallowing challenges.

Other Treatments

Speech Therapy: Speech therapy can help with issues with chewing and swallowing.
Physically Feeding: Physically feeding food to the person, but not forcefully, may be necessary.
Tube Feeding (Enteral Feeding): Tube feeding is only used on a case-by-case basis. One analysis from 2019 found that tube feeding people with dementia does not lead to weight gain. Tube feeding carries risks of tube blockage, leakage, and infection.
Appetite Stimulants: For example, if a decreased appetite is the issue, some people may benefit from an appetite stimulant medication, which can work to increase feelings of hunger.

Medical Foods

The pursuit of novel dementia treatments has led to the development of novel nutritional interventions such as medical foods. Medical foods are not dietary supplements owing to legal definitions, and variation exists cross-nationally as to whether a medical prescription is necessary for their use, thus complying with the pharmacotherapy framework of this review. The term medical food is defined as “a food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation” . In contrast, dietary supplements are products (e.g., capsules, liquids, or soft gels) that contain a dietary ingredient intended to add to the nutritional value of the diet . Both medical foods and nutritional supplements have been developed to improve dementia outcomes, but for the sake of brevity and the focus of this review on pharmacotherapies, only medical foods are discussed here. Treatment rationales for medical foods are based on specific micronutrient needs that arise from underlying disease pathologies, and that may not be met by simply modifying the usual diet. Of high relevance for this review, medical foods may also provide a way to combat BW loss. For AD, three medical foods are being developed that claim to offer symptomatic relief: Axona®, CerefolinNAC®, and Souvenaid®. Axona® provides a ketogenic agent that targets metabolic deficiencies in AD . Results from a multi-center RCT show that APOE-4 (an important AD-susceptibility gene) negative patients with mild-to-moderate AD taking Axona®, improve on the Alzheimer’s Diseases Assessment Scale-Cognitive subscale after 90 days . It should be noted that 23% of patients in the treatment arm discontinued the trial because of adverse events, mostly related to the gas- trointestinal system. CerefolinNAC® addresses the hyperhomocysteinemia and oxidative stress associated with disorders such as MCI and AD. CerefolinNAC® increases the bioavailability of folate and vitamin B12. One prospective case-control study has shown that CerefolinNAC® significantly slows cognitive decline in dementia disorders compared with no treatment . The third medical food, Souvenaid® , acts as a vehicle for the Fortasyn Connect formulation and was designed to deliver a specific combination of nutritional precursors and cofactors for phospholipid synthesis that are essential for the synthesis of neuronal membranes and synaptic function . Deterioration of neuronal membranes and synaptic function have been shown to underlie cognitive decline in AD . Several industry-sponsored clinical trials assessing the efficacy of Fortasyn Connect at various stages of AD have been completed; however, evidence remains inconclusive. Randomized controlled trials have reported modest positive outcomes for once-daily treatment on the measures of cognitive

The Downside of Dementia Medications

Despite the positive cognitive effects of AChEIs, numerous phase IV clinical trials note an unintentional side effect that may be cause for concern. In a meta-analysis of AChEI treatment in AD, it was shown that there was an almost three-fold higher odds of the adverse event, BW loss, among patient groups taking AChEIs compared with placebo treatment groups. Furthermore, this BW loss was associated with adverse gastrointestinal side effects . Notably, AChEIs induce dose-dependent nausea, vomiting, anorexia, and diarrhea caused by cholinergic hyperstimulation of the internal muscarinic receptor in the gastrointestinal tract . Since the market approval of AChEIs, the association between AChEI treatment and BW loss has been investigated. One group observed a 23% risk of BW loss in individuals with dementia taking AChEIs , while others concluded AChEI treatment is protective against BW loss seen in dementia (however, the latter study lacked a control group). Crucially, in a meta-analysis of 25 clinical AChEI trials and others, an increased risk of BW loss was observed for every AChEI . This provided the first report of pooled estimates of effect addressing whether AChEIs may cause BW loss in dementia.

When Weight Loss Continues

For some people, modifying meal habits and offering different foods may help stabilize weight. In cases of weight loss caused by health issues or problems with dentures or swallowing, addressing the underlying issue may also help.

For others, weight loss may still progress. Cachexia is a condition that causes rapid muscle wasting and fat loss. In this condition, a person’s metabolism changes so that even if enough food is consumed, weight loss will continue. People with advanced dementia may have cachexia, particularly at the end of life.

Weight Loss as an Early Sign of Dementia

“While intentional weight loss can be beneficial for health, unintentional weight loss, especially in older adults, may reflect underlying neurodegeneration or other health conditions,” says lead study author Zimu Wu, PhD, a research fellow at Monash University in Australia. Brain changes that start years before dementia symptoms appear may affect metabolism, appetite, mobility, and daily function, Dr. Wu says. All of these things can lead to unintended weight loss. Adults Who Developed Dementia More Likely to Experience Rapid Weight Loss For the study, researchers followed 5,390 older adults for more than a decade, starting when they were 77 years old on average and free of dementia. All of the participants were cognitively healthy at the start of the study and had multiple tests over time for several dementia risk factors such as body weight, waist circumference, blood pressure, and cholesterol levels. A total of 1,078 people developed dementia. Compared with people who didn’t develop dementia, those who did have more rapid declines in body weight and waist circumference during the study period, according to findings published in JAMA Network Open. Along with faster weight loss, dementia patients also experienced a significantly bigger reduction in waist circumference in the decade before their diagnosis than their cognitively healthy peers did over that same time period, the study found.

Read also: The Vegan Diet-Dementia Link

The Importance of Maintaining Good Cognitive Health

Even so, there are many steps older adults can take to stay cognitively healthy as they age, such as eating a healthy diet, staying physically active, engaging in social and mental activities, managing stress, and maintaining a positive mood, Wu says. The study findings also suggest that it makes sense to get a checkup if your weight drops and you’re not sure why, Wu adds.

Where Can I Find Additional Information and Support?

The Alzheimer’s Association has message boards for virtual support. You can also contact Meals on Wheels for information about free meals for seniors. Your doctor can connect you with support in your community as well. Mealtime can feel stressful when a person with dementia isn’t eating or is struggling with food. Unintentional weight loss can be concerning and lead to complications.

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