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AuthorsDr Junaid Bajwa, GP Principal and Board Member of Greenwich Clinical Commissioning GroupGwen Coleman, Registered DietitianMark Lawton, Consultant Nurse, dementia care Supported by Nutricia Advanced Medical Nutrition.
The importance of nutrition in the management of early Alzheimer’s disease
IntroductionAmong the pledges in the NHS mandate recently announced by Health
Secretary Jeremy Hunt is a commitment to drive up diagnosis rates of
dementia.1 This builds on similar undertakings outlined in the Challenge on
Dementia initiative launched earlier in 2012.2 With hundreds of thousands of
people with dementia currently living without a proper diagnosis,3 these moves
should help improve the management of dementia and early Alzheimer’s
disease.
However, there is a danger that the drive for earlier diagnosis of Alzheimer’s
disease will amount to very little, unless it is matched by an equal commitment
to providing high-quality care to people once they are diagnosed. This care
must be holistic, person-centred and focused as much on adding life to years
as it is on adding years to life.
If there is to be a significant increase in the number of people diagnosed
while in the early stages of Alzheimer’s disease, management and personal
care plans must be formulated that not only take advantage of recent drug
developments, but also include lifestyle interventions such as exercise, mental
stimulation and nutrition.
The importance of nutrition Good nutrition is essential for people with Alzheimer’s disease. A healthy,
well-balanced diet is essential to maintaining physical strength and good
general health. It is a valuable source of enjoyment and interaction for people
with Alzheimer’s disease and their carers, and can help those living with the
disease remain engaged and socially active, even as their cognitive abilities
begin to decline.
There is also increasing evidence that nutrition plays an important role in the
aetiology and progression of Alzheimer’s disease itself. Research suggests
certain macro and micronutrients are involved in the decline of cognitive
function and in the risk of developing Alzheimer’s disease.
Several dietary risk factors for Alzheimer’s disease have been identified,
including high intakes of saturated fat,4 raised plasma cholesterol5
and obesity.6 There is also a growing body of epidemiological evidence
suggesting certain nutrients offer protection against the condition.
There appears to be a lower risk and slower progression of Alzheimer’s
disease in people who regularly eat a ‘Mediterranean diet’ high in vegetables
and fish oils.7, 8
Diets high in omega 3 polyunsaturated fatty acids (PUFAs), vitamin E,
folate and vitamin B12 have also been linked with a reduced risk of
Alzheimer’s disease.9,10
These diets are largely in line with well-established nutritional advice for the
reduction of cardiovascular risk factors, the prevention of diabetes, obesity
and hypertension. It increasingly appears that what is good for the heart is also
good for the brain. It therefore seems sensible to include nutritional and dietary
measures as early as possible in the management of Alzheimer’s disease.
However, a number of challenges remain in the pursuit of this goal.
Nutritional intervention in Alzheimer’s diseaseUnfortunately, the early signs and symptoms of Alzheimer’s disease often
remain undiagnosed until cognitive decline is significantly advanced.
Even once a patient is diagnosed, the patient’s nutritional status is often not
considered in early disease, with no intervention being made unless there is
an obvious problem such as obesity or overt malnutrition.
The very nature of Alzheimer’s disease can also present significant barriers to
obtaining a nutritionally adequate diet. Alzheimer’s disease may be associated
with changes in taste patterns or functional difficulties that interfere with
chewing, swallowing and the preparation of food. Cognitive impairments
can make it difficult to remember or follow dietary advice. Individual social
circumstances - isolation or low income for instance - may also present
difficulties in obtaining an adequate diet. And many people with Alzheimer’s
disease suffer comorbidities, such as depression, hypertension or diabetes,
that may also impact on appetite or require difficult dietary restrictions.
Many of these challenges can be overcome by the involvement of health or
social care staff with specialist knowledge in nutritional intervention. Dietitians
or appropriately trained nursing, medical or social care staff can offer valuable
assistance in obtaining all the nutrients necessary for good general health and
optimal cognitive functioning. This is in line with the National Institute for Health
and Clinical Excellence (NICE) quality standard on dementia which states: ‘An
integrated approach to provision of services is fundamental to the delivery of
high quality care to people with dementia’.11
However, for this to happen, it is essential that health and social care staff are
sufficiently aware of the importance of nutrition in early Alzheimer’s disease and
that those with the condition receive a full nutritional assessment as early as
possible in the progress of their disease. Unfortunately, this ideal appears to
be some way removed from the reality of current practice.
Rethinking nutrition and early Alzheimer’s disease This report makes the case for a fundamental rethink on the position of nutrition in early Alzheimer’s disease.
It will:• Review the evidence on the importance of nutrition in the management
of early Alzheimer’s disease• Discuss the ideal diet for someone in the early stages of Alzheimer’s disease• Investigate the role that individual nutrients play in the aetiology of
the disease• Ask how can we use this knowledge to offer people with Alzheimer’s disease
the very best nutritional support.
We will then look at current practice and the results of a survey, commissioned
for this report, of 1,006 GPs and 100 elderly care specialists involved in the
diagnosis and/or treatment of people with early Alzheimer’s disease.13
The results are discussed further later in this report; however, the findings
suggest that while most specialists recognise the importance of nutrition in
early Alzheimer’s disease, very few offer an effective and comprehensive
nutritional assessment. Only 33 per cent of elderly care specialists routinely
assess diet and nutrition during the diagnosis of early Alzheimer’s disease.
Only 22 per cent of GPs expect nutrition to be routinely assessed as part of
the diagnostic process of Alzheimer’s disease.13
Access to specialist dietetic support is both poor and under-used. Over half
of elderly care specialists and GPs in the survey were unsure of the role that
nutrition might play in the pathology of Alzheimer’s disease.
There appears to be a clear need for greater awareness about the importance
of nutrition in Alzheimer’s disease and for improved knowledge on the part that
nutritional management may play in care of the condition.
We have therefore made a number of recommendations on how current
practice could be improved.
We propose improvements to staff training and access to specialist
dietary services.
We also offer guidance on the kind of dietary and nutritional advice that could
be given to people living with Alzheimer’s disease and their carers.
1 2
CONTENTSIntroduction 1
The importance of nutrition 1
Nutritional intervention in Alzheimer’s disease 2
Rethinking nutrition and early Alzheimer’s disease 2
Nutrition in Alzheimer’s disease in practice 3
Nutrition and Alzheimer’s disease 4
Nutritional protection 4
Nutritional risk factors 4
Hearts and minds 4
How Alzheimer’s disease may affect nutrition 5
How nutrients may affect Alzheimer’s disease 5
Current practice 6
Characteristics of selected screening tools 6
Recommendations 7
Conclusion 7
References 7
There is a danger that the drive for earlier diagnosis of Alzheimer’s disease will amount to very little, unless it is matched by an equal commitment to providing high-quality care to people once they are diagnosed.
It increasingly appears that what is good for the heart is also good for the brain.
The Patient Experience “The thing with Alzheimer’s or dementia is that we appear quite normal; people can’t see our problems. If patients come into hospital it should be accepted now that patients are assessed for their cognitive ability, because it’s only by assessing your cognitive ability, that you can assess if there’s something wrong with it”.12
Ann Johnson, who lives with Alzheimer’s disease
The results of our survey clearly suggest that while the importance of good nutrition is well recognised among specialists working with people with Alzheimer’s disease, the role of nutritional support is often neglected in the management of the condition’s early stages.
3 4
Nutrition and Alzheimer’s diseaseEpidemiological studies have produced a growing body of evidence to
suggest that nutrition plays a key role in the development and progression of
Alzheimer’s disease. A number of nutritional and dietary factors have been
identified that may increase the risk of Alzheimer’s disease or protect
against it.
The dietary pattern approach – our growing knowledge of how individual
nutrients affect Alzheimer’s disease has given us a valuable insight into how
these specific elements in the diet influence progression of the condition.
However, putting this information into practice is complicated by the fact that
humans rarely consume individual nutrients in isolation. Normal diets contain
complex combinations of nutrients that are likely to have a range of synergistic
effects.14 This has led to an approach known as ‘dietary pattern’ analysis, in
which nutrients are investigated in the various combinations in which they
usually occur. These ‘patterns’ or combinations appear to have a stronger
impact than the individual nutrients themselves.9
Nutritional risk factorsRaised plasma cholesterolHigh serum total cholesterol has been shown to be an independent risk factor for a number of neurodegenerative disorders including Alzheimer’s disease.5 In particular, high cholesterol has been linked with the development of the brain plaques that are associated with Alzheimer’s disease. However, the relationship between high cholesterol and Alzheimer’s disease appears to be complex and trials using cholesterol-lowering drugs in Alzheimer’s disease have, so far, proved disappointing.18
Saturated and trans fatty acidsDiets that include a high intake of saturated or trans-unsaturated (hydrogenated) fats, found mainly in animal fats, have been shown to increase the risk of Alzheimer’s disease. In one study of 815 people aged 65 years or older, none of whom had Alzheimer’s disease at the outset, 131 had developed the disease four years later.4 The researchers found that those with the highest levels of saturated fat intake had 2.2 times the risk of developing Alzheimer’s disease compared with those with the lowest levels. The risk also increased with the consumption of trans fats.
ObesityPeople who are obese in middle age have been shown to be twice as likely to develop dementia compared with those of a more healthy weight.6 This study, which followed 1,500 elderly subjects for an average of 21 years, also found that high cholesterol and high blood pressure in midlife raised the Alzheimer’s disease risk by up to six times.
Hearts and mindsFor many years healthcare professionals have been offering dietary advice specifically aimed at reducing cardiovascular risk factors such as obesity, high cholesterol and hypertension. More recently it has become clear that what is good for the heart is also good for the brain.19 A low fat, high-fibre diet with plenty of fruit, fish and vegetables is likely to offer as much protection against dementia as is does against cardiovascular disease.20 This is good news for healthcare professionals who have limited time to assess their patients and offer practical, meaningful advice. Alzheimer’s disease-focussed dietary advice does not mean re-writing the rule book. In many cases it will mean simply expanding on what healthcare teams should already be doing for the general good health of their patients.
Nutritional protectionMediterranean dietMany of the nutrients listed below, which have been found to offer a protective effect against Alzheimer’s disease, occur in abundance in the typical Mediterranean diet. Diets which contain high levels of fish, fruit, unsaturated fatty acids, vegetables rich in anti-oxidants and moderate amounts of wine, are associated with a reduced risk and slower progression of Alzheimer’s disease. 7, 8
Omega-3 PUFAsIt has been known for a number of years that diets high in omega-3 PUFAs may reduce Alzheimer’s disease risk. One recent study found that a diet rich in omega-3 PUFAs, vitamin E and folate, reduced the risk of Alzheimer’s disease by 40 per cent in those subjects who adhered best to the diet compared with those who adhered the worst.9
AntioxidantsAntioxidants, whether obtained through the diet or in the form of vitamin E and vitamin C supplements, have been shown to offer a measure of protection against Alzheimer’s disease.10 It is thought that these vitamins help protect the ageing brain from the oxidative damage associated with pathological changes in Alzheimer’s disease.
B vitaminsIt is known that inadequate intakes of B vitamins can cause a rise in plasma homocysteine, which is a risk factor for the development of Alzheimer’s disease.15 B vitamin supplementation has been shown to slow brain atrophy in people with high baseline homocysteine.16
WineModerate consumption of wine has been associated with a lower risk of developing Alzheimer’s disease.17
64 per cent of elderly care specialists think that there is good evidence linking vitamin B12 with good cognitive function.
64%
B12
In November 2012 a detailed survey13 was carried out to investigate the practice of 100 specialists in elderly care in the UK. All of the survey participants were involved in the diagnosis of Alzheimer’s disease and fell into one of the following categories:
• A psychiatrist with a subspecialty in old-age psychiatry• A geriatric medicine specialist with a subspecialty in old age psychiatry• A general internal medicine specialist with dual accreditation in old
age psychiatry
The results showed that:
89%
Almost 9 out of 10 (89 per cent) elderly care specialists think it is important to educate people with Alzheimer’s disease about a healthy diet.
5 out of 10 elderly care specialists are unsure of the role nutrition might play in the pathology of Alzheimer’s disease (53 per cent).
83 per cent of elderly care specialists feel the importance of nutrition in Alzheimer’s disease is to maintain general good health compared with 6 per cent who believe nutrition has a therapeutic benefit.
83%
Only one-third of elderly care specialists routinely assess diet/nutrition during the diagnostic process for suspected Alzheimer’s disease.
33%
1 in 5 elderly care specialists do not think diet, weight or BMI are relevant to the diagnostic process of early Alzheimer’s disease (22 per cent).
22%
Less than a third of elderly care specialists have access to a dietitian for people with early Alzheimer’s disease (29 per cent).
29%
53%
Nutrition in Alzheimer’s disease in practice
Of those elderly care specialists who don’t routinely assess diet and nutrition, 1 in 5 (20 per cent) of them have never considered nutritional assessment, while others don’t think it is relevant.
20%
People living with Alzheimer’s disease have been shown to have relatively low levels of certain nutrients in their bodies despite eating a normal diet.
The Patient Experience “Marco was first worried...he kept asking me what the day was, and what we were doing, and endlessly repeating it, and I was getting cross, as you do, when you don’t understand…Once we got the diagnosis, I listened to the doctor very carefully; Marco fell asleep. It left me feeling confused and alone and totally unsure about what I could do to help my husband”.12
Kate Harwood – Family carer
5 6
Current practiceNutritional assessment and screeningThere are a number of clinical tools available to assess nutritional status and
screen patients for deficiencies (see Table 1). However, most of these tools
are primarily designed to identify malnutrition. Little, if any, attention is paid
to the effect of the diet on cognitive decline. Moreover, as the results of the
survey make clear, most of these tools are currently used only sparingly, or not
at all. Nutritional assessment tends to take place only when there is an obvious
problem such as malnutrition or obesity; or when the patient’s condition
has advanced to the point where they can’t prepare food, are experiencing
severely diminished appetite, or they have been admitted to hospital.
Tool Target group Tool comprises
Malnutrition Universal Screening Tool (MUST)
Adult patients in hospital, community and all care settings
3 sections: BMI*, unplanned weight loss, acute disease effect; score and management plan
Nutrition Risk Screen (NRS) Adult & child hospital patients
5 sections: BMI/percentile chart, weight loss, appetite, ability to eat/retain food, stress factor
Subjective Global Assessment (SGA)
Adult hospital patients 2 sections: history of: weight loss, dietary intake change, gastro-intestinal symptoms, functional capacity, disease, physical signs of wasting, oedema, ascites
Malnutrition Screening Tool (MST)
Adult hospital patients 3 questions: unintentional weight loss, amount of loss, dietary intake/appetite
Derby Nutritional Score (DNS) Adult hospital patients 7 sections: body weight for height, mobility, gastro-intestinal symptoms, skin condition, appetite and dietary intake, psychological state, age
Mini Nutritional Assessment & Short Form (MNA SR)
Older adults 6-item initial screen: BMI, recent weight loss, mobility, cognitive/mood state, appetite and eating. If ‘at risk’, proceed with full 18-item version
Nutritional Risk Index (NRI) Older adults 16-item questionnaire: medical history, medications, eating abilities, dietary habits and intake, smoking, weight change
Nutritional Risk Assessment Scale (NuRAS)
Older adults 12-item questionnaire: medical history, eating abilities, medications, cognitive/mood state, social habits, weight loss
Characteristics of selected screening tools32
How Alzheimer’s disease may affect nutritionEven in the early stages of Alzheimer’s disease the symptoms of the condition can
present significant barriers to obtaining a nutritionally adequate diet.21 Alzheimer’s
disease is often associated with changes in taste patterns or, in the later stages,
functional difficulties that interfere with chewing, swallowing and the preparation of
healthy food.
Cognitive impairments can make it difficult to remember or follow dietary
advice. Individuals’ social circumstances - isolation or low income for instance
- may also present difficulties in obtaining an adequate diet.
Many people with Alzheimer’s disease suffer comorbidities, such as dental
problems, depression, hypertension or diabetes that may have their own
impact on appetite or require difficult dietary restrictions. Lack of exercise may
also lead to a loss of appetite.
Many of the nutritional challenges of Alzheimer’s disease can be overcome
by the involvement of health or social care staff with specialist knowledge in
nutritional intervention. Indeed, professional guidelines, including those from
NICE22 and the Royal College of Nursing,22 stress that care plans for people
with Alzheimer’s disease should be person-centred and include nutritional
management.
Dietitians or appropriately trained nursing, medical or social care staff can offer
valuable assistance in obtaining all the nutrients necessary for good general
health and the best possible cognitive functioning.
Phosphocholine
CDP-choline
Phosphatidylcholine
Phospholipids Choline
Omega-3 fatty acids
B-vitamins
anti-oxidantsUridine
Cofactors
New neuronal membrane
One of the key features of early Alzheimer’s disease is the loss of synapses22 - the connections within the brain that allow the transmission of electrical or chemical signals. Loss of synapses is associated with the loss of memory.24
Alzheimer’s disease focussed dietary advice does not mean re-writing the rule book. In many cases it will mean simply expanding on what healthcare teams should already be doing for the general good health of their patients.
Kennedy EP, Weiss SB. The function of cytidine coenzymes in the biosynthesis of phospholipides. Biol Chem 1956;222:193–214.
How nutrients may affect Alzheimer’s diseaseOne of the key features of early Alzheimer’s disease is the loss of synapses24
- the connections within the brain that allow the transmission of electrical or
chemical signals. Loss of synapses is associated with the loss of memory.25
Because people with Alzheimer’s disease are losing synapses more rapidly
than would otherwise be expected, they have a higher requirement to
synthesise new ones.
Synapse formation depends on a process known as the Kennedy Cycle.23
The Kennedy Cycle involves a number of nutrients as precursors (uridine,
omega-3 PUFAs and choline) and as cofactors (B-vitamins, phospholipids
and antioxidants).26
However, people living with Alzheimer’s disease have been shown to have
relatively low levels of certain nutrients in their bodies despite eating a
normal diet. Specifically:
• Low brain levels of the omega-3 PUFA docosahexanoic acid (DHA) are associated with cognitive decline and Alzheimer’s disease27
• Plasma folate levels are reduced in Alzheimer’s disease28
• Plasma vitamin B12, vitamin C and vitamin E levels are reduced in Alzheimer’s disease29
• Uptake of choline is reduced in the ageing brain30
• Uridine monophosphate synthesis is reduced in people with Alzheimer’s disease.31
The biochemical pathway for synthesising new neuronal membranes23
Table 1
* BMI = body mass index
The Kennedy Cycle
7
References 1. Department of Health. What does the Mandate mean for people with dementia?
[Online] 2012. Available at: http://mandate.dh.gov.uk/dementia [Accessed November 2012].
2. Department of Health. Prime Minister’s challenge on dementia [Online] 2012. Available at: http://www.dh.gov.uk/health/2012/03/pm-dementia-challenge/ [Accessed November 2012].
3. Alzheimer’s Society. Increase in number of people diagnosed with dementia: over 400,000 remain undiagnosed, according to Alzheimer’s Society [Online]. Available at: http://www.alzheimers.org.uk/site/scripts/news_article.php?newsID=1164 [Accessed November 2012].
4. Morris MC, Evans DA, Bienias JL et al. Dietary fats and the risk of incident Alzheimer disease. Arch. Neurol. 2003;60(2):194–200.
5. Notkola IL, Sulkava R, Pekkanen J et al. Serum total cholesterol, apolipoprotein E epsilon 4 allele, and Alzheimer’s disease. Neuroepidemiology. 1998;17(1):14–20.
6. Kivipelto M, Anttila T, Fratiglioni L et al. P2-278 Body mass index, clustering of vascular risk factors and the risk of dementia: a longitudinal, population-based study. Neurobiology of Aging. 2004;25:S311.
7. Solfrizzi V, Frisardi V, Seripa D et al. Mediterranean diet in predementia and dementia syndromes. Curr Alzheimer Res. 2011;8(5):520–542.
8. Vassallo N, Scerri C. Mediterranean Diet and Dementia of the Alzheimer Type. Curr Aging Sci. 2012.
9. Gu Y, Nieves JW, Stern Y et al. Food combination and Alzheimer disease risk: a protective diet. Arch. Neurol. 2010;67(6):699–706.
10. Zandi PP, Anthony JC, Khachaturian AS et al. Reduced risk of Alzheimer disease in users of antioxidant vitamin supplements: the Cache County Study. Arch. Neurol. 2004;61(1):82–8.
11. NICE. Dementia [Online]. Available at: http://publications.nice.org.uk/dementia-quality-standard-qs1 [Accessed December 2012].
12. RCN. Dementia. Commitment to the care of people with dementia in hospital settings [Online] 2012. Available at: http://www.rcn.org.uk/__data/assets/pdf_file/0011/480269/004235.pdf [Accessed November 2012].
13. 100 specialists were surveyed online. Fieldwork was conducted by MedeConnect Healthcare Insight 2–16 November 2012.
14. Jacobs DR Jr, Gross MD, Tapsell LC. Food synergy: an operational concept for understanding nutrition. Am. J. Clin. Nutr. 2009;89(5):1543S–8S.
15. Quadri P, Fragiacomo C, Pezzati R et al. Homocysteine, folate, and vitamin B-12 in mild cognitive impairment, Alzheimer disease, and vascular dementia. Am. J. Clin. Nutr. 2004;80(1):114–122.
16. Sachdev PS. Homocysteine and brain atrophy. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2005;29(7):1152–61.
17. Letenneur L, Larrieu S, Barberger-Gateau P. Alcohol and tobacco consumption as risk factors of dementia: a review of epidemiological studies. Biomed. Pharmacother. 2004;58(2):95–9.
18. Matsuzaki T, Sasaki K, Hata J et al. Association of Alzheimer disease pathology with abnormal lipid metabolism The Hisayama Study. Neurology. 2011;77(11):1068–75.
19. Fillit H, Nash DT, Rundek T et al. Cardiovascular risk factors and dementia. Am J Geriatr Pharmacother. 2008;6(2):100–18.
20. Alzheimer’s Association. Adopt a Brain-Healthy Diet | Alzheimer’s Association [Online]. Available at: http://www.alz.org/we_can_help_adopt_a_brain_healthy_diet.asp [Accessed November 2012].
21. Alzheimer’s Society. Eating and drinking [Online]. Available at: http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=149 [Accessed November 2012].
22. NICE. Dementia. Supporting people with dementia and their carers in health and social care [Online] 2006. Available at: http://www.nice.org.uk/nicemedia/live/10998/30318/30318.pdf [Accessed November 2012].
23. Kennedy EP, Weiss SB. The Function of Cytidine Coenzymes in the Biosynthesis of Phospholipides. J. Biol. Chem. 1956;222(1):193–214.
24. Scheff SW, Price DA, Schmitt FA et al. Synaptic alterations in CA1 in mild Alzheimer disease and mild cognitive impairment. Neurology. 2007;68(18):1501–8.
25. Scheff SW, Price DA, Schmitt FA et al. Hippocampal synaptic loss in early Alzheimer’s disease and mild cognitive impairment. Neurobiol. Aging. 2006;27(10):1372–84.
26. Zeisel SH. Choline: Critical Role During Fetal Development and Dietary Requirements in Adults. Annu Rev Nutr. 2006;26:229–50.
27. Jicha GA, Markesbery WR. Omega-3 fatty acids: potential role in the management of early Alzheimer’s disease. Clin Interv Aging. 2010;5:45–61.
28. Smach MA, Jacob N, Golmard J-L et al. Folate and homocysteine in the cerebrospinal fluid of patients with Alzheimer’s disease or dementia: a case control study. Eur. Neurol. 2011;65(5):270–8.
29. Glasø M, Nordbø G, Diep L et al. Reduced concentrations of several vitamins in normal weight patients with late-onset dementia of the Alzheimer type without vascular disease. J Nutr Health Aging. 2004;8(5):407–13.
30. Cohen BM, Renshaw PF, Stoll AL, et al. Decreased brain choline uptake in older adults. An in vivo proton magnetic resonance spectroscopy study. JAMA. 1995;274(11): 902–7.
31. McWilliam C, Smith N, Stead M. Nutrition: the importance in early Alzheimer’s disease. Innovation in Healthcare. 2012:44–5.
32. Perry L. Using nutritional screening tools to identify malnourished patients [Online]. Available at: http://www.nursingtimes.net/nursing-practice/clinical-zones/nutrition/using-nutritional-screening-tools-to-identify-malnourished-patients/1958881.article [Accessed November 2012].
The Patient Experience “My hope would be for people to understand it more, to get rid of the stigma of dementia”.12
Ann Johnson who is living with Alzheimer’s disease.
Recommendations The results of the survey clearly suggest that while the importance of good
nutrition is well recognised among specialists working with people with
Alzheimer’s disease, the role of nutritional support is often neglected in the
management of the condition’s early stages. We believe this needs to change.
Specifically there is a need for:
• A raised awareness among staff, carers and people with Alzheimer’s
disease of the importance of nutrition in Alzheimer’s disease and
dementia
• Better nutritional support during the pre-diagnosis stage and the
early stages of Alzheimer’s disease
• Nutritional assessment to be carried out as a matter of course in
suspected Alzheimer’s disease cases
• The development of better assessment tools that focus on the
nutritional value of diet, as well as calorific intake
• Better nutritional training for health and social care staff
• Better access to dietetic support, especially for people with early
Alzheimer’s disease
• Recommended daily intakes to be developed for people with
Alzheimer’s disease to include Omega-3 PUFAS, vitamin E, folate,
vitamin B12 and vitamin B6.
Conclusion In the UK alone there are more than 820,00031 people living with dementia. This number is expected to double over the next 30 years; nearly 400,000 of these people are unaware that they have the condition.
Alzheimer’s disease is a multifactorial condition that requires multidisciplinary care. In recent years it has increasingly been recognised that this care should be patient-centred, holistic, and incorporate lifestyle factors such as diet and exercise, as well as pharmaceutical intervention. It should focus as much on adding life to years as it does on adding years to life.
The NHS prioritises patient-centred solutions, and provides both guidance and infrastructure to support people with Alzheimer’s disease from the point of diagnosis. The NICE quality standards stress the importance of an integrated multidisciplinary approach to the management of the condition. However, it appears that important steps at diagnosis, such as nutritional assessments, are being missed by healthcare professionals. This is due to poor awareness of the role that good nutrition can play in maintaining physical strength and brain function.
We believe that implementing the recommendations in this report will help raise awareness among health and social care staff, as well as providing them with the tools to offer a more comprehensive nutritional assessment and better dietary support. This will ensure that nutrition takes its rightful place as a cornerstone of patient-centred Alzheimer’s disease care from the outset.
Editorial support provided by Mark Hunter.
This report has been produced in conjunction with independent authors. It has been supported by Nutricia Advanced Medical Nutrition which has provided editorial and financial support.
©January 2013