Dementia is a growing global health concern, characterized by a progressive decline in cognitive abilities. While research focuses on slowing cognitive decline, it's crucial to address other aspects that significantly impact the well-being of individuals with dementia, such as unintentional weight loss. This article explores the complex relationship between dementia and weight loss, examining the causes, potential consequences, and strategies for effective management.
The Prevalence and Significance of Weight Loss in Dementia
Unintentional weight loss is a common and troublesome issue for people living with dementia. Research indicates that a substantial proportion, ranging from 20% to 45%, of community-dwelling individuals with dementia experience weight loss within a year. This frequency tends to increase as the severity of dementia progresses, with a higher percentage observed in the more advanced stages of the illness. Gradual or noticeable weight loss can lead to increased frailty and adverse health outcomes.
Obesity in Mid-Life as a Risk Factor
Obesity in mid-life may be a risk factor for developing dementia in late life.
Complex Causes of Weight Loss in Dementia
The mechanisms underlying weight loss and undernutrition in dementia are complex, multifactorial, and only partly understood. Direct and indirect causes of weight loss in dementia patients complicate things. A shrinking brain impacts the ability to recognize foods. Cognitive decline and external stressors can trigger mealtime forgetfulness. Reduced appetite, increased activity, and, in the more advanced stages of the illness, the disruption of eating and feeding behaviors by cognitive and behavioral problems all play a part.
Several factors can contribute to weight loss in individuals with dementia:
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Appetite Loss
Dementia often results in appetite loss due to brain disorders that compromise hunger signals and the drive to eat. Cognitive problems and apraxia might make meal recall or regulation difficult. Depression, common in those with dementia, lowers appetite. Age-related loss of smell and taste can affect the desire to eat.
Difficulties with Eating and Swallowing
Dysphagia, or difficulty swallowing, is a common problem, affecting up to 57% of people with advanced dementia. It can make eating and drinking unpleasant or dangerous, causing individuals to avoid certain foods and liquids and leading to malnutrition and dehydration. Cognitive problems associated with dementia can further complicate things, as individuals may struggle to express their dietary preferences or adhere to meal guidelines. Difficulties moving food or liquid from the mouth to the stomach can cause choking, aspiration, and malnutrition.
Cognitive Decline and Behavioral Changes
Cognitive decline in late-stage dementia might alter eating patterns and preferences. One may develop a loss of appetite, difficulty identifying food, and a taste for sweeter or more familiar meals. Meals could be disrupted by pacing, nervousness, and restlessness. Eating can be challenging for individuals who fidget, pace, or become confused.
Medication Side Effects
Medications for depression and dementia may reduce appetite. The use of acetylcholinesterase inhibitors (AChEIs), which are employed to treat cognitive symptoms associated with dementia, can also lead to weight loss. Medications with anticholinergic effects, sometimes used in the treatment of dementia, may lead to decreased appetite and memory impairment.
Other Contributing Factors
Other issues that may cause weight loss can include: underlying health issues, dentures that don’t fit, lack of exercise, embarrassment from trouble with eating and changes in the smell or taste of food. Social isolation and depression can cause a loss of appetite and weight.
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The Impact of Dementia Subtypes on Weight Trends
Different types of dementia also affect weight trends, as well as the stage of the disease. Early on in Alzheimer’s Disease, weight may not change. However, in moderate to severe stages, weight loss may become noticeable. Frontotemporal dementia may initially cause hyperphagia and weight increase but can later lead to weight decrease. The effects of strokes on eating-related motor and cognitive skills can influence the weight changes associated with vascular dementia. Both weight and appetite might be affected by Lewy body dementia. Weight loss in Lewy body dementia (LBD) is more than in Alzheimer’s. LBD raises the susceptibility to malnutrition, which can lead to extreme weight loss. Unlike later stages of Alzheimer’s Disease, LBD-related weight loss may be associated with dietary changes and alterations in appetite.
Recognizing Warning Signs
It’s important to be aware of the signs that a person with dementia is having trouble during meals. These 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. Weight loss of 5% of body weight over 6-12 months warrants investigation.
The Consequences of Unintentional Weight Loss
Unintentional BW loss is detrimental for the frail elderly because it is associated with higher rates of mortality, institutionalization, adverse health outcomes, decline in functional status, and overall poorer quality of life. In elderly with dementia, unintentional BW loss is associated with syndrome severity, higher rates of institutionalization, a higher incidence of behavioral problems, and ultimately mortality. Rapid weight loss in dementia can be rather dangerous for health and suggest disease progression. The rapid weight loss of dementia can lead to drooping skin, frailty, and fatigue. Food rejections and forgetfulness could aggravate weight loss.
Strategies for Managing Weight Loss in Dementia
A key finding in this report is that while weight loss is a common problem for people with dementia, undernutrition can and should be avoided. There are several strategies that can be implemented to address weight loss and improve nutritional intake in individuals with dementia:
Modifying Meal Habits and Environment
Changing certain habits can help with forgetting to eat or other distractions. Examples include: serving food one course or item at a time, removing distractions from the environment (table decor, noise, activity, etc.), offering finger foods, offering familiar or favorite foods, serving soft foods to people with swallowing issues, eating with the person, offering plenty of fluids to prevent dehydration, setting aside dedicated mealtimes and encouraging daily exercise to stimulate appetite.
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Dietary Approaches
The implementation of nutritional approaches is of paramount importance. A diet heavy in lean proteins, fruits, and vegetables helps preserve muscle mass and integrity. Offering smaller, more frequent meals and ensuring the food tastes good and is easy to eat will help consumption. Severe weight loss or malnutrition may require dietary supplements recommended by a dietitian.
Medical Foods
The pursuit of novel dementia treatments has led to the development of novel nutritional interventions such as medical foods. Medical foods may also provide a way to combat BW loss. 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.
Addressing Underlying Issues
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. In cases of weight loss caused by health issues or problems with dentures or swallowing, addressing the underlying issue may also help.
Considering Alternative Feeding Methods
Tube feeding (enteral 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. The hospice philosophy of food and fluid intake is that we encourage eating but never force.
Medication Management
Medications for dementia can profoundly change weight. An orexigenic antidepressant, mirtazapine, can restore appetite and weight gain in people with dementia and co-morbid depression. See a doctor to ensure the medicine is suitable and monitor its effects.
The Role of Healthcare Professionals
Undernutrition, once established, is a serious health concern requiring medical attention and input from a dietician and occupational therapy as appropriate. All care homes and hospitals that care for people with dementia need to develop and implement plans to optimise and monitor their nutritional status.
The Importance of a Holistic Approach
Managing weight loss in dementia requires a holistic approach that considers the individual's physical, cognitive, and emotional needs. Eating is a social activity, and more thought should be given to how this can be optimised, normalised and made a core aspect of person-centred care. This includes creating a supportive and comfortable mealtime environment, providing assistance with feeding when needed, and addressing any underlying medical or psychological issues that may be contributing to weight loss.
COVID-19 Precautions in Dementia Care Facilities
As the coronavirus (COVID-19) pandemic continues to evolve, communities focused on keeping Residents and staff safe while also maintaining Resident engagement and daily fulfillment. Measures include screening every employee every day, monitoring Residents’ health closely, enhancing cleaning products, testing all Residents and staff regularly, installing ultraviolet lights in air conditioners, enhancing HVAC filters, and ensuring staff members wear masks at all times. These precautions are essential for protecting vulnerable individuals with dementia during the pandemic.