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Weight loss and undernutrition in community-dwelling patients with Alzheimer’s dementia

From population based studies to clinical management

Gewichtsverlust und Unterernährung bei selbstständig lebenden Patienten mit Alzheimer-Demenz

Von populationsbasierten Studien zum klinischen Management

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Abstract

Weight loss and undernutrition are commonly described in patients with Alzheimer’s disease (AD) and have been associated with various adverse outcomes. Therefore, it is important to know what the best approach is to community-dwelling AD patients with a risk of developing a poor nutritional status; however, there is currently no evidence on which to base nutritional recommendations. Expert based recommendations are that the nutritional status should be part of the work-up of all AD patients. If weight loss of 5 % or more has occurred in 3–6 months or if the mini-nutritional assessment (MNA) classifies a patient as undernourished, a nutritional intervention should be started. The intervention should be multifactorial and encompass treatment of the underlying proposed causes and risk factors of weight loss and undernutrition as well as improvement of the nutritional status by increasing energy and protein intake combined with daily physical activity.

Zusammenfassung

Gewichtsverlust und Unterernährung werden bei Patienten mit Demenz vom Alzheimer-Typ (AD) häufig beschrieben, beides ist assoziiert mit einer Reihe unerwünschter Folgen. Den optimalen Ansatz zu kennen für AD-Patienten, die nicht in betreuten Einrichtungen leben und bei denen das Risiko der Entwicklung eines ungünstigen Ernährungzustandes besteht, ist daher von hoher Relevanz. Leider gibt es bisher noch keine Evidenz, auf der Ernährungsempfehlungen basieren könnten. Nach auf Expertenmeinungen beruhenden Empfehlungen sollte das Management des Ernährungszustands integraler Bestandteil bei der Betreuung aller AD-Patienten sein. Mit einer Intervention zu beginnen empfiehlt sich entweder bei einem Gewichtsverlust von mehr als 5% in 3–6 Monaten oder bei der Klassifizierung eines Patienten als unterernährt nach dem MNA (Mini Nutritional Assessment). Eine solche multifaktorielle Intervention sollte sowohl Risikofaktoren und die zugrundeliegenden Ursachen für Gewichtsverlust und Unterernährung berücksichtigen als auch die Verbesserung des Ernährungszustandes über erhöhte Energie- und Proteinaufnahme anstreben, in Kombination mit täglicher körperlicher Aktivität.

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Authors and Affiliations

  1. Department of Geriatric Medicine, Medical Center Leeuwarden, PO Box 888, 8901 BR, Leeuwarden, The Netherlands

    E. Droogsma MSc & D. van Asselt MD, PhD

  2. Department of Neurology and Alzheimer Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

    P. P. De Deyn MD, PhD

  3. Department of Neurology and Memory Clinic, ZNA and Laboratory of Neurochemistry and Behavior, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium

    P. P. De Deyn MD, PhD

Authors
  1. E. Droogsma MSc
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  2. D. van Asselt MD, PhD
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  3. P. P. De Deyn MD, PhD
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Correspondence to E. Droogsma MSc.

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Conflict of interest

E. Droogsma received funding from the Wetenschapsfonds MCL (Science Institute of the Medical Center Leeuwarden MCL), Frision (the research foundation of the department of geriatric medicine of the MCL) and Neurosearch Antwerp VZW. D. van Asselt and P.P. De Deyn declare that there are no conflicts of interest.

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Droogsma, E., van Asselt, D. & De Deyn, P. Weight loss and undernutrition in community-dwelling patients with Alzheimer’s dementia. Z Gerontol Geriat 48, 318–324 (2015). https://doi.org/10.1007/s00391-015-0891-2

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  • DOI: https://doi.org/10.1007/s00391-015-0891-2

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