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Nutritional monitoring in patients with Dementia

Nutritional monitoring in patients with Dementia

We interviewed Simone Pinto, a nutritionist specializing in Gerontology, to clear up the main doubts about nutritional support for those with dementia.

According to the World Health Organization, Dementia "[is] an umbrella term that describes the loss of memory, intellectual capacity, reasoning, social skills and changes in normal emotional reactions." It is estimated that there are 47.5 million people with dementia worldwide, a figure that could almost triple by 2050 to 135.5 million.

Since Dementia is more common in people aged 65 and over, we invited nutritionist Simone Pinto, a specialist in Gerontology, to talk about nutritional care for patients with some form of Dementia.

Nutritional assessment, how is it done?

Simone tells us that, depending on the elderly person, nutritional aspects such as obesity and malnutrition can often be found. That's why it's so important to carry out a nutritional assessment at the first consultation. Below, we talk about the 3 types of assessments that nutritionists usually carry out with their patients:

Biochemical evaluation

Evaluation of tests carried out in the last 6 months, such as: blood count, lipid count, total proteins and fractions, vitamin D, vitamin B12, folic acid, iron, ferritin, urea, creatinine, sodium, potassium and calcium.

Dietary assessment

Ask the patient and/or caregiver about the timing and number of meals, quantity of food, consistency and types of liquids, and whether they already take any supplements.

Clinical and anthropometric assessment

It measures: weight, height, BMI, percentage of lean mass and fat, calf, arm and abdominal circumference. It assesses the appearance of the skin, whether there are any lesions or dehydration. In the early stages of the disease, it also measures handgrip strength.

Other assessments carried out: mini mental examination, clock test and MoCA test. In addition, Katz and Barthel scales, to assess degrees of activities of living and dependencies.

Ask the caregiver and/or patient about the frequency and consistency of stools and the appearance of urine. Check for food refusal, oral stasis from food or medication and binge eating.

Based on this complete assessment, the nutritionist is able to evaluate and prescribe a diet that best fits the patient's routine and needs.

Frequency of nutritional consultations

For Simone, at the beginning of the guidelines, it's important to schedule appointments at least once a month in order to monitor adaptation. However, in the event of an acute situation, she recommends bringing the visit forward and increasing the frequency to once a week until normalization.

And after the adaptation period, appointments can be at longer intervals. Once every three months is enough, she says.

As mentioned above, BMI is part of the nutritional assessment. This is very important information, as the elderly generally tend to lose weight as they get older, and Dementia can intensify this change.

Simone says that "[even] with adequate calorie intake, there is a tendency to lose weight. This weight loss is related to a reduction in body fat, but also in muscle mass, especially when sarcopenia develops in an advanced stage. And sarcopenic obesityis also common."

Difficulties in feeding patients with dementia

The nutritionist says that it is normal for caregivers to report difficulties at mealtimes. This occurs mainly when the patient is unable to hold food in their mouth and eat on their own. Sometimes the patient may spit up when eating meat, pieces of fruit or other foods with different consistencies. For this situation, it is recommended to adjust the consistency of the meal.

Supervision during mealtimes is recommended, as the patient may eat compulsively without realizing it. It is also important not to leave food exposed or easily accessible, so that it is not ingested, and to take care to leave cleaning products out of reach.

What to do when the patient lacks appetite?

According to Simone, "[a] lack of appetite can present itself as food refusal, because the patient doesn't recognize the food at some point."

Avoiding stimuli at mealtimes, such as turning on the television, can help a lot with concentration and appetite.

Simplifying and rethinking eating times can help

Using less cutlery, acrylic glasses - with handles to hold them -, deep plates and thinking of unique menus, such as soufflés and escondidinhos, in smaller portions so that they don't get cold quickly, are good alternatives. In addition, in order not to distract the person, the nutritionist also recommends serving only their plate with the food; too many portions in front of them can lead to confusion.

She goes on to say that, "if the patient is walking [at mealtimes], offering food sticks, such as carrot and cucumber sticks, sighs, small sandwiches, cheese rolls or cheese cubes and pieces of fruit, can make it easier."

In the milder and early stages of dementia, she suggests that the caregiver opt for foods that the patient prefers and use food supplements to increase calorie density.

Specific supplements that help with brain health and cognition are also welcome. Relevant nutrients for dementia patients Simone also told us which nutrients she considers to be extremely important for the nutrition of dementia patients.

Zinc, Magnesium, Vitamin E, Vitamin C, B-complex Vitamins, Vitamin D and EPA/DHA, UMP, Phospholipids, Choline, Capric Acid and Caprylic Acid.

According to her, the "Mediterranean diet is an excellent guide. We should pay attention to protein sources and the consumption of red meat, which can be 3-4 times a week, alternating with fish, poultry, pork, legumes and eggs. Milk and dairy products, oil seeds, olive oil and berries are also important. Coconut and avocado should be encouraged. And don't forget vegetables."

On the other hand, processed foods - where you'll find more trans fats and sodium - should be avoided.

The importance of multidisciplinary teamwork

Simone Pinto highlights the role of each professional during treatment: "The multi-team is extremely important, the geriatrician helps with medication issues, to adjust the symptoms that appear during the process, as well as the neurologist who can also be called in, as medication management is not always easy, especially during phase changes.

The physiotherapist and occupational therapist will be important for maintaining the patient's functionality and independence. And the psychologist plays an important role in supporting the family. Music therapy is also very important at all stages. It helps to control symptoms such as agitation.

The nursing team and caregivers help the patient with basic activities and Nutrition helps the family, caregivers and the patient to manage the stages of dementia with a better nutritional status.

Speech therapy may also be required because of the risk of bronchoaspiration, which occurs over time."

Stimuli, adaptations and support in different aspects are fundamental at times of change like this. In our article "A caring look at Alzheimer's disease", we share the story of a grandson who took care of his grandmother and faced the disease with more lightness and good humor. Check it out by clicking HERE.

Nutritionist Simone Pinto

She teaches several courses in the field of Gerontology.
Volunteer nutritionist at the Foundation for Support and Valorization of the Elderly - FAVI, and member of the board of SBGG-PR.
Master in Education from PUC and Specialist in Gerontology, certified by the Brazilian Society of Geriatrics and Gerontology - SBGG.
Specialist in Clinical Nutrition (UFPR) and Collective Health (UP).

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