Weight loss is common in elderly people with dementia, particularly those with Alzheimer's disease (AD), and feeding difficulties are major issues in their care in the later stages of the disease. The aetiology is still uncertain and appears multifactorial. Hypotheses to explain the weight loss have been suggested (e.g. atrophy of the mesial temporal cortex, biological disturbances, and higher energy expenditure), but none has been proven. More than half of the AD patients of one recent study  developed body-weight loss; overall, the AD patients were significantly thinner than non-demented subjects. Anthropometric and laboratory measures suggested a poorer nutritional status and fewer daily physical activities in AD patients. While most of them had poor appetite, their daily calorie intake was not significantly different from that of the control group. In fact, patients with body weight loss consumed more calories per body weight kilogram per day. In the food composition analysis, AD patients consumed more carbohydrates than controls. The authors concluded that the pathophysiological process in AD gives rise to changes of appetite and metabolic state in AD patients, and that these changes contribute to weight loss.
In another longitudinal study , the authors studied the changes in nutritional variables in a cohort of patients with a probable diagnosis of
AD. All subjects were submitted to nutritional, neuropsychological, and functional evaluation. The results showed that only the interview and the checklist that explored caregiver burden predicted weight loss in AD patients, suggesting the possibility that caregivers who consider themselves overburdened by the disease process are not willing to invest adequate resources to allow AD patients to properly nourish themselves.
Clinical observation, among AD patients, of periods of weight gain, periods of acute weight loss, and greater fluctuations in weight suggest that the natural history of weight change in AD may be characterised by dysfunction in body weight regulation. However, it remains a fundamental concept that a nutritional education program for caregivers of AD patients is the best way to prevent weight loss and improve the nutritional status of these patients.
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