Introduction

There is little that is easy about managing the effects of Alzheimer's disease (AD). Maintaining nutrient status as the disease progresses is just one of the challenges faced by both people with AD and their caregivers. Adequate nutrition is a worthy goal, however, as it can provide a better quality of life and help preserve stamina, resist infections, and promote good wound healing.

Illness hinders eating

While no two people experience Alzheimer's disease in the same way, there are common signs that can indicate a decline in nutrition status. In the early stage of the disease, for example, some people may experience depression that leads to loss of appetite. Others may forget to eat, or, conversely, gorge themselves. During this stage, it is helpful for caregivers to establish a baseline body weight of the person with AD, to provide them with frequent reminders to eat, and to monitor their safety if they continue to cook their own meals.

As the disease progresses, the individual with AD will require increasingly greater assistance with meal preparation and, eventually, even with eating. During the later stages, more serious dietary problems can arise. For example, many people with AD wander and/or engage in restless movements that create an increased need for calories, while others may develop behavioral, physical, or neurologic problems that interfere with food intake.

Issues affecting food intake and eating include confusion, anxiety, loss of muscular control in the mouth, difficulties with chewing and swallowing, impairment of hunger and appetite regulation, agitation that makes sitting still for a meal impossible, and dental problems. These factors can make weight loss a key issue.

Some practical meal strategies

The first step in recognizing these changes in dietary status is to be aware that a problem exists, and to relay concerns to the appropriate responsible party. Other suggestions include:

• Offering meals at regular, consistent times each day
• Allowing sufficient time for eating
• Creating a calm dining environment. Turn off the television and radio. Soft background music may be helpful
• Using dishes without a pattern. White usually works best
• Using a simple place setting with a single eating utensil. Remove other items from the dining table
• Serving only one food at a time, or serving one-dish meals such as casseroles
• Using bowls so that scooping food is easier, and using other adaptive equipment such as special spoons as necessary
• Serving food that is easy to pick up with the fingers. Good choices include sandwiches cut into quarters, chicken nuggets or small pieces of cooked boneless chicken, fish sticks, cheese cubes, halved hard boiled eggs, fresh fruit and soft vegetables cut into bite sized pieces, French fries, and ice cream sandwiches
• Serving soup in mugs
• Offering regular drinks of water, juice, and other fluids to avoid dehydration

It's an ongoing effort

Realize too, that despite the best efforts of the caregivers, Alzheimer's disease is almost inevitably accompanied by weight loss. This is not an indictment of the quality of caregiving, but rather a facet of the disease. A reasonable goal may simply be to maintain awareness of the person's nutrient needs and status, and to attempt to meet those needs in a manner that best accommodates individual circumstances.