Alzheimer’s DIsease and Dementia Part 2- Medical Treatment and Nutritional Interventions

Dementia

group of symptoms involving decline in memory, reasoning, and cognition due to brain cell damage

Alzheimer’s disease

degenerative brain disease that is the most common cause of dementia

Dementia vs Alzheimer’s

dementia is a symptom cluster, Alzheimer’s is a specific disease

Alzheimer’s diagnosis

based on medical history, physical exam, neurological exam, cognitive testing, and brain imaging

Mild cognitive impairment (MCI)

early stage with slight memory and thinking changes but ability to perform daily activities remains

MCI symptoms

forgetting words, difficulty remembering names, trouble organizing and planning

MCI intervention timing

best stage for dietary and lifestyle interventions

Moderate Alzheimer’s disease

stage with increased confusion, memory loss, and behavioral changes

Moderate stage symptoms

confusion about identity, location, and time, sleep changes, wandering

Severe Alzheimer’s disease

advanced stage with loss of communication, movement, and swallowing ability

Severe stage care

requires 24-hour care and increased infection risk

Alzheimer’s and pneumonia

common cause of death due to swallowing difficulties

Mediterranean diet and MCI

higher adherence associated with reduced progression to Alzheimer’s disease

Insulin resistance and cognition

reducing insulin resistance may improve memory and cognitive function

Intranasal insulin

shown to improve memory and cognition in patients with MCI or Alzheimer’s

Aducanumab (Aduhelm)

FDA-approved drug targeting beta-amyloid plaques in Alzheimer’s disease

Aducanumab concerns

mixed evidence, risk of brain swelling, high cost

Cholinesterase inhibitors

medications that prevent breakdown of acetylcholine to improve memory and cognition

Cholinesterase inhibitor side effects

nausea, vomiting, loss of appetite, increased bowel movements

Glutamate regulators

medications that regulate glutamate to improve memory and thinking

Glutamate regulator side effects

headache, dizziness, confusion, constipation

Orexin receptor antagonists

medications used to regulate sleep-wake cycle

Orexin antagonist side effects

impaired alertness, depression, sleep behaviors, breathing issues

Mealtime environment for AD

limit distractions and keep settings simple

Meal presentation

distinguish food from plate and serve one to two foods at a time

Eating assistance

allow extra time and eat with the individual

Utensil considerations

use safe utensils such as soft-coated spoons

Memory and eating

individuals may not remember if they have eaten

Taste changes in AD

preference for sweeter foods due to decreased taste sensation

Finger foods

helpful for individuals who cannot sit or use utensils

Adaptive equipment

scoop dishes and non-slip mats help with eating

Swallowing concerns

monitor for choking and consider texture modifications

Response time in AD

may have up to 90-second delay when responding

Prompt hierarchy

stepwise approach to assist with eating while maintaining independence

Stimulus control

presenting utensils or food to initiate action

Verbal support

encouraging statements without instruction

Verbal directive

simple one-step instructions

Gesture cue

pointing or motioning toward object

Modeling

demonstrating action while giving guidance

Manual guidance

light touch to assist movement

Manual response block

stopping unsafe or repetitive actions

Hand-over-hand assistance

guiding movement through task

Physical assistance

completing task for individual

Chaining

gradually reducing assistance as individual learns steps of task

Enteral nutrition in AD

may be considered in advanced stages when oral intake is inadequate

Weight loss in AD

common due to decreased intake, memory issues, and disease progression

Nutrition focus in AD

maintain intake, support independence, and prioritize quality of life