Introduction

Alzheimer’s disease (AD) is a form of dementia that interferes with a person’s intellectual and social functioning. As the disease progresses, caregivers are faced with different health and nutritional issues. Providing adequate nutrition may be challenging, but it is a worthy goal that preserves the person’s health and well-being.

Nutritional Concerns and Recommended Guidelines

There are a few nutritional concernst that may be common with individuals who have Alzheimer’s Disease (AD).  Weight loss can be due to eating problems such as poor-fitting dentures, problems in swallowing, and loss of appetite. Weight loss or loss of appetite may also be caused by noise, odor, and/or conversation distractions while eating.  To improve symptoms in some individuals, encourage eating a well-balanced diet rich in vitamins and minerals and engage in regular activity or exercise.  Daily physical activity increases appetite, muscle strength, joint flexibility, and bone density, and decreases nervous tension.
 
Symptoms of AD are unique for every individual. Some people may have loss of appetite, and some may forget to eat, while others gorge themselves. In the early stages of AD, it is helpful to establish baseline body weight. As the disease progresses, the individual with AD will need more assistance with shopping and food preparation.

Common Health Concerns Related to Alzheimer’s Disease

Dental Health

• Good dental health increases quality of life and overall nutrition.
• Pay attention to how dentures fit, especially if a person loses weight.

How to assess if someone is having dental problems:

• Refusal to eat, especially hard-to-chew or cold foods.
• Frequent pulling or touching of face or mouth.
• Taking or leaving out previously worn dentures.
• Moaning or shouting.
• Inability to sleep.
• Refusal to participate in daily activities.
• Restless or aggressive behavior.

Chewing and Swallowing

• Allow ample time for each meal. Do not rush.
• In some cases, gently remind to chew the food, and swallow.
• Encourage upright 90-degree sitting position. If the person’s head tilts backward, carefully move it to a forward position.
• Serve soft foods such as pudding, ice cream, cottage cheese, yogurt, applesauce, scrambled and boiled eggs, mashed potatoes, cream of wheat, cream or blended soups, cornmeal mush, or bananas. (Depending on the type of dysphasia, thick liquids may be more difficult to swallow).
• Grind or cut in bite-size pieces foods such as cooked meat, turkey, or chicken.
• Make sure the food is not too hot or too cold.
• Serve cooked or baked fish, or tuna or chicken salad instead of large pieces of meat.
  Learn the Heimlich maneuver so you can help if the person starts choking.
• Avoid foods such as nuts, popcorn, or raw carrots that may lodge in the throat. You can grind nuts finely and serve them as a topping.
• Check if the person has swallowed all the food at the end of the meal.

Weight Management

• Eat 6-8 small meals throughout the day to keep energy level up.
• Drink high-energy drinks such as Boost, Ensure, or Carnation Instant breakfast for a snack.
• Have a tablesppon of peanut butter or honey on bread, biscuits, or rolls.
• Use margarine or butter on steamed vegetables.
• Add canned meats such as tuna and chicken to packaged rice, potato, or macaroni mixes.  Meats pack in extra calories and protein.

Sundowning and Shadowing

Sundowning occurs in the late afternoon and evening. The person with AD may become demanding, upset or disoriented, and suspicious, and see or hear things that are not there. It is not known why this behavior happens. Factors that may contribute to it include poor visibility in dim light, hormonal imbalance, increased fatigue and restlessness at the end of a full day of activities, or the caregiver communicating his or her fatigue to the person with AD.

Shadowing refers to when a person with AD follows or mimics the caregiver, or talks, asks questions, and interrupts recurrently. Shadowing often accompanies sundowning.

• Provide an early dinner or a late-afternoon snack.
• Serve whole-wheat pasta, oatmeal, bagels, rice cakes, toast, or dry fiber cereal with no milk. All these foods are rich in carbohydrates. Carbohydrates are calming because of their effect on brain chemistry.
• Encourage foods that are rich in vitamin B6; they also have a calming effect. Foods rich in vitamin B6 are bananas, sweet potatoes, potatoes, and whole-grain cereals.
• Make caffeine-free teas such as chamomile or green tea. Serve them with toast or rice cakes.
• Offer the person a piece of sugarless gum. Chewing may have a calming effect. Make sure that a person is able to chew and swallow easily.
• Avoid foods and drinks high in caffeine such as coffee, tea, soda, or chocolate or limit them to the morning hours to reduce agitation and nervousness.

Approaches for Healthy Lifestyles

Vitamin and Mineral Supplements

Adults aged 65 and over may be deficient in Vitamin E, B12, thiamine, and zinc. These vitamins and minerals are important in neurological and cognitive function and may be linked to AD.  Recommendations regarding supplements and special diets should come from registered dietitians and physicians.

Meal Preparation Strategies

• Allow plenty of time for each meal.
• Offer meals at regular intervals each day.
• Eat every meal in the same area.
• Serve smaller meals more often rather than three large ones.
• Use plain white plates and bowls with different-colored place mats to reduce confusion.
• Give a person only needed utensils.
• Use straw for drinking.
• Avoid plastic utensils since they may break.
• Put one food on the plate at a time or serve one-dish meals, such as casseroles.
• Put condiments on food before serving.
• Avoid serving steaming hot or boiling liquids or foods.
• Use a mug for soup.
• Use a bowl instead of a plate for easier scooping.
• Serve finger foods such as chicken nuggets, small pieces of cooked chicken or fish, sandwiches cut in quarters, fish sticks, cheese cubes, cut boiled eggs, cut fresh fruit, and soft vegetables such as cooked potatoes, zucchini, cauliflower, and broccoli.
• Limit very salty or sweet foods if the person has a chronic condition, such as hypertension or diabetes.

Environment

• Create a calm, quiet, familiar, and comfortable home environment.
• Be consistent – keep furniture in the same place.
• Use soothing colors on the walls, such as peach, pink, ivory, beige, lavender, and light blues, and greens. Use flat paint instead of semi-gloss or high-gloss to decrease glare.
• Use non-shiny, simple floor surfaces to prevent confusion or carpeting to reduce noise.
• Avoid lighting that creates stark shadows that may disturb the person.
• Make sure that the kitchen area is well-lit.
• Provide soft background music and include the person’s favorite songs.

Ideas for increasing physical activity:

• Be aware of the person’s past activities and hobbies.
• Create a sense of routine; it is okay to do the same activity at the same time each day.
• Doing simple tasks such as sweeping or dusting may create a sense of accomplishment.
• Create activities that may be similar to those of a person’s former career.
• Encourage dancing or playing an instrument.
• Take regular walks around the block or to the neighborhood store.
• Promote gardening, raking leaves, and outdoor activities.
• Household activities such as setting the table, washing dishes, or doing laundry will increase the person’s daily movement.