(7) Alzheimer's disease
Alzheimer's disease, the most common form of dementia,
primarily affects people over the age of 65 years. About 8 per cent of
people over 65 have Alzheimer's disease, and the prevalence doubles every
five years, with 30 per cent of the population over 85 being affected.
The condition begins with cognitive disorders that gradually worsen. Other
symptoms include orientation difficulties, loss of independence and disordered
eating patterns. In addition, weight loss is common, which can lead to
increased risk of infection, falls, skin ulcers, and, as a consequence,
a deterioration in quality of life. It is therefore worthwhile helping
to prevent or reduce these nutritional difficulties as much as possible.
Weight loss in Alzheimer's disease may be caused by reduced energy intake.
As the disease progresses, patients experience reduction in functional
capability, such that shopping, meal preparation and eating become more
difficult. Weight loss may be caused by increased energy requirements
due to agitation and stress, although the evidence for differences in
energy expenditure between healthy people and those with Alzheimer's disease
is limited.
- To optimise nutrition in the patient, it is necessary to focus on
both the carer and the patient.
- Try to find what the patient eats. If she or he lives alone and appears
to be anorexic or eats sporadically with few "proper meals,"
recommend a home help or services to bring meals into the home.
- The diet should be varied, with bread, fruit or vegetables and dairy
products at each meal if possible.
- Meat, fish or eggs should ideally be consumed at least once a day.
- Fluid intake should be liberal. Patients should be given as much liquid
as they want.
- Consider enriched foods or food supplements (eg, Complan, Ensure)
- Deficiency of vitamin B12 and folate are associated with Alzheimer's
disease, but whether this is a cause or an effect is not clear from
available evidence.
- A multivitamin/mineral supplement may be recommended.
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This series of “dietary advice tips” is intended
to be a reminder of the main points to be made by pharmacists when giving
nutritional information to the public. The conditions included in the
series are those where diet is a well recognised risk factor, those in
which diet contributes to the management of the condition, and others
for which patients may welcome sound dietary advice.
Written by Dr Pamela Mason (a pharmacist with a postgraduate qualification
in nutrition)
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