Dementia and Alzheimer’s disease

Dementias are neurological diseases that cause progressive deterioration of the brain's cognitive and intellectual function. In the "physiological" aging process the organs, including the brain, undergo a process of deterioration. The degree and speed of aging and the magnitude of brain deterioration vary widely from one individual to another, but in dementias this deterioration is greater and is very accelerated.

This brain deterioration affects higher mental functions such as memory, thinking, reasoning, planning, organization or speech, which as it progresses will seriously interfere with the ability to carry out activities of daily life.

Alzheimer's disease is the most common type of dementia in our society, but there are other types such as vascular dementias due to multiple and small infarcts that occur within the brain, dementia associated with chronic infections (such as dementia associated with the virus of human immunodeficiency and Creutzfeldt-Jakob disease), Lewy body dementia, Pick's disease, and Wilson's disease and Parkinson's disease dementias. Alzheimer's disease, dementia with Lewy bodies and Pick's disease are dementias in which we do not know their origin, so they are called primary; the others are secondary forms. We will refer to primary dementias and, specifically, to Alzheimer's disease, although many concepts to which we will refer are valid for any form of dementia.

Alzheimer's disease can affect anyone over 45 years of age, although it manifests more commonly after age 65. Its duration and the rate of evolution vary, with the average survival rate, from its appearance in well-cared patients, from 8 to 10 years.

The causes of Alzheimer's disease are not known. It is thought to be of multifactorial origin, including genetic, inflammatory, viral, environmental, etc. risk factors. Some dietary factors associated with the development of Alzheimer's disease have been described, such as a high intake of total fat and saturated fat. While consuming oily fish, a rich source of omega 3 polyunsaturated fatty acids would protect from developing the disease.

The clinical picture of Alzheimer's disease is highly variable from one patient to another but characteristically begins with the loss of recent memory and attention, which is followed by language problems, especially finding certain words, and impaired thinking abstract and of judgment and reasoning. Other symptoms that accompany memory impairment in the early stages are mood or character changes, irritability, mood swings (such as sadness) and hostility, while sociability decreases. All these manifestations are the response that the patient has when noticing the small "gaps" in his memory, in his language or in his ability to reason and make judgments.

These manifestations progressively worsen and others are added, such as the inability to learn and retain new information, the loss of orientation over time, and the loss of recognizing places and people. This disorientation causes the patient to have a tendency to move aimlessly, wander, and wander erratically for hours. In addition, episodes of delirium, agitation, hostility, lack of cooperation, and verbal or physical aggression will appear.

Cognitive impairment makes it difficult for the patient to carry out activities of daily life, which become increasingly difficult as the disease progresses. You will need help eating, dressing, washing, etc., while you are at increased risk of falls and other accidents. This difficulty in feeding, even with help, puts patients at risk of malnutrition, aspiration pneumonia, and pressure ulcers.

The evolution of the disease reaches advanced stages, where the patient presents a state of silence, of total impairment to move, does not control their simpler physiological functions (urinary and stool incontinence) and reaches a total disconnection with the environment that surrounds you. The final stage is death, usually due to some intercurrent process, for example, an infection.

There is no treatment to cure dementia, although there are currently some treatments that can slow down its natural evolution. However, from a nutritional point of view, we are going to be able to greatly help patients with Alzheimer's disease and any type of dementia.

Alzheimer's disease and dementias in general produce negative alterations in the nutritional status of the patient, which are what we will be able to modify and treat. Let's review them briefly.

Malnutrition and weight loss: In many of these patients the nutritional intake will be insufficient, which carries the highest risk of infections and skin ulcers. Malnutrition and weight loss are often due to several causes:

Once nutritional problems have been identified, we will act accordingly. Here are some practical solutions to avoid malnutrition, weight loss, and the risk of injury or complications in people with dementia:

Aspects related to nutrition:

Aspects not related to nutrition:

• • Loss of appetite (secondary to depression and dementia itself).
  • Distraction or neglect (forgetfulness) of the patient.
  • Confusion of schedules.
  • Difficulty chewing and swallowing.
  • Hyperactivity (which makes the patient forget to eat).
  • Refusal or refusal to eat (because of the depressive state or as a "childish").
  • Involuntary movements of the mouth (caused by the disease itself or by its treatment), which make it difficult to eat.
  • Inattention (which causes the patient to tire quickly and not complete the meal).
  • Inability to eat by himself (decreased ability to perform coordinated movements and correctly use cutlery or other objects used to eat).
  • Inability to recognize objects or even not see them, which will prevent you from identifying food or food sources.
  • Changes in the senses of smell and taste, with decreased salivation, which will alter the perception of flavors and which will contribute to the refusal to eat food.
  • Increased energy expenditure: Many Alzheimer's patients in moderate or advanced stages wander and wander erratically, do so at a constant pace for hours (increasing energy expenditure), or have periods of agitation during which they increase their energy expenditure. We must not forget either that these patients present intercurrent infectious episodes (pneumonia or urinary infections) that produce an overconsumption of body reserves and further deteriorate their nutritional status.
  • Other aspects to consider refer to the fact that the digestive system may have its functions slowed down, and it may present difficulty in bowel evacuation due to constipation; fecalomas, more frequent in these patients, also make defecation difficult.
  • Eat frequent and small meals (for example, 5 or 6 meals a day).
  • Use the maximum variety of foods.
  • Choose foods according to the patient's preferences.
  • Take care of the presentation of the dishes. They should be dishes that attract the attention of the patient, with a wide range of colors and shapes, and not repeat them.
  • Food should be smooth and homogeneous textures.
  • Ensure a high intake of proteins, both of animal and vegetable origin. They are found in meat, fish, eggs, milk, legumes.
  • Carbohydrates are a good source of energy, but you have to avoid consuming excess simple sugars.
  • Fats improve the taste of food and are a vehicle for fat-soluble vitamins and essential fatty acids. We must increase the contribution of unsaturated and polyunsaturated (olive, sunflower, soy, fish, etc.) and decrease saturated (animal fats, etc.).
  • The contribution of vitamins and minerals is achieved with the inclusion in the diet of vegetables, fruits and fresh vegetables.
  • Give blue fish, which are rich in polyunsaturated fat.
  • Ensure the intake of at least one and a half liters of water and fluids a day, even if the patient does not feel thirsty; in case of difficulty swallowing use thickeners.
  • Increase the intake of foods rich in fiber to promote intestinal activity and avoid constipation. Fiber is found in vegetables, fruits, legumes, and whole grains. It will be accompanied by a greater intake of fluids (4 to 6 glasses of water a day).
  • Avoid astringent foods (rice, chocolate, etc.).
  • In case of constipation: it is useful to take 2 or 3 plums on an empty stomach, an infusion of flax seeds or a yogurt with crushed plums before breakfast or a fiber supplement.
  • Avoid cheeses with a doughy and / or hard consistency.
  • Avoid fibrous meats that are difficult to chew.
  • Avoid whole nuts.
  • Avoid sweets that stick to the palate.
  • Remove the bones from the fish.
  • Prepare foods that the patient can eat with their hands, without the need for utensils, such as croquettes, meatballs or squid a la romana.
  • Avoid alcoholic beverages, trying to drink water, natural fruit juices and herbal teas.
  • Ensure dairy intake for its high protein content and rich in calcium and vitamin D (important to prevent bone fractures).
  • Follow a regular meal schedule: every day at the same time and in the same room.
  • Eat sitting at the table and in a quiet environment to avoid distractions.
  • Eat slowly and chew your food well.
  • Avoid distractions during meals such as the television, children playing in the same room, phone calls, etc.
  • Food must always be at an adequate temperature since in advanced stages of the disease, the patient does not distinguish between hot and cold and is highly exposed to injury.
  • If the patient is at risk of injury, use plastic utensils (glasses, plates, cutlery) that do not break.
  • Treat swallowing difficulty (dysphagia) when it occurs:
  • Cut into small pieces or shred the food.
  • Use thickeners with liquids. Pharmaceutical thickeners, gelatins, or cornmeal can be used.
  • Administer foods in pureed or porridge texture.
  • Soften solid foods by adding liquids (milk, broth, sauces) to achieve smooth textures.
  • Modify the way you eat: eat small amounts of food at one time, chew well and slowly, and allow enough time for swallowing; do not add food in the mouth, without having swallowed the above.
  • Avoid dry and sticky foods and those that spread through the mouth, such as cookies.
  • Do not speak while eating or drinking.
  • Diet will be adapted if the patient has other pathologies (diabetes mellitus, high blood pressure, increased cholesterol).
  • Adapt the house by eliminating obstacles and adapting it as the patient's disability evolves.
  • Try to maintain some social activities with friends, neighbors, family, etc. to distract yourself and feel accompanied.
  • Go for a daily walk in quiet hours and familiar places.
  • Bathing is a good time to check the condition of the skin, nails, and areas most at risk of ulceration.
  • Simplify dressing and grooming by using easy-to-fasten and slip-on clothes and shoes.
  • Night rest is important, so a routine of schedules, environment, etc. must be established. If necessary, pharmacological help can be requested.
  • Carry out health education for the patient, family and / or caregiver, to promote self-feeding and care for artificial nutrition (if necessary), in all stages of the disease.
  • The moral support of the healthcare professional and the family can be important for the patient's recovery.
  • It is important that families participate in family associations, in order to cope with the disease in a better way.