1
|
Arifin H, Chen R, Banda KJ, Kustanti CY, Chang CY, Lin HC, Liu D, Lee TY, Chou KR. Meta-analysis and moderator analysis of the prevalence of malnutrition and malnutrition risk among older adults with dementia. Int J Nurs Stud 2024; 150:104648. [PMID: 38043486 DOI: 10.1016/j.ijnurstu.2023.104648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Aging and dementia are common and closely related health problems in older adults, affecting their ability to maintain a healthy diet and ultimately resulting in malnutrition. OBJECTIVE In this study, we estimated the global prevalence of malnutrition and malnutrition risk in older adults with dementia. DESIGN Meta-analysis. DATA SOURCES Embase, Ovid MEDLINE, PubMed, CINAHL, Scopus, and Web of Science were comprehensively searched for articles published from database inception to October 2022. METHODS Pooled prevalence analysis was conducted using a generalized linear mixed model and a random-effects model. I2 and Cochran's Q statistics were used for identifying heterogeneity. Publication bias was evaluated using Peters' regression test and a funnel plot. Moderator analyses were conducted to investigate variations in the prevalence estimates of the included studies. All statistical analyses were conducted using R software. RESULTS A total of 16 studies involving a total of 6513 older adults with dementia were included in the analysis. The results indicated that 32.52 % (95 % confidence interval: 19.55-45.49) of all included older adults with dementia had malnutrition, whereas 46.80 % (95 % confidence interval: 38.90-54.70) had a risk of malnutrition. The prevalence of malnutrition was found to be high among older patients living in institutionalized settings (46.59 %) and those with Alzheimer's disease (12.26 %). The factors moderating the prevalence of malnutrition included adequate vitamin B12 consumption, risk behaviors, medical comorbidities, and certain neuropsychiatric symptoms. The prevalence of malnutrition risk was high among women (29.84 %) and patients with Alzheimer's disease (26.29 %). The factors moderating the prevalence of malnutrition risk included total cholesterol level, vitamin B12 consumption, risk behaviors, medical comorbidities, and certain neuropsychiatric symptoms. CONCLUSIONS Approximately one-third of older adults with dementia are malnourished and nearly half of older adults are at a risk of malnutrition. Encouraging collaboration among health-care professionals and ensuring early assessment and effective management of malnutrition are crucial for maintaining a favorable nutritional status in older adults with dementia. REGISTRATION This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022369329). TWEETABLE ABSTRACT Globally, approximately 32.52 % of older adults with dementia are malnourished and approximately 46.80 % are at a risk of malnutrition.
Collapse
Affiliation(s)
- Hidayat Arifin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia. https://twitter.com/ha_arifin
| | - Ruey Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Kondwani Joseph Banda
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Endoscopy Unit, Surgery Department, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Christina Yeni Kustanti
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum, Yogyakarta, Indonesia
| | - Ching-Yi Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Hui-Chen Lin
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan
| | - Doresses Liu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tso-Ying Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Nursing Research Center, Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kuei-Ru Chou
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan; Research Center in Nursing Clinical Practice, Wan Fang Hospital Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
2
|
Tanaka H, Nagata Y, Ishimaru D, Ogawa Y, Fukuhara K, Nishikawa T. Clinical factors associated with activities of daily living and their decline in patients with severe dementia. Psychogeriatrics 2020; 20:327-336. [PMID: 31883310 DOI: 10.1111/psyg.12502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/11/2019] [Accepted: 12/10/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND To identify the clinical factors affecting activities of daily living (ADL) at baseline and after 6 months. METHODS We conducted a single-centre observational study at two time points across 6 months (baseline and after 6 months) from April 2015 to March 2017. in a 270-bed rural recuperation hospital at Hyogo prefecture in Japan. The total number of participants was 131 (male 33, female 98; mean age: 87.0 ± 7.0; mild and moderate dementia, 38; severe dementia, 93). Measurement scales used were Personal Self-Maintenance Scale (PSMS) for assessing ADL, Mini-Mental State Examination and Cognitive Test in Severe Dementia (CTSD) for cognitive function, Neuropsychiatric Inventory-Nursing Home version and Cornell Scale for Depression in Dementia (CSDD) for behavioural/psychological symptoms of dementia, Mini Nutritional Assessment Short form (MNA-SF) for nutritional status, Pain Assessment in Advanced Dementia for pain, and Charlson comorbidity index (CCI) and the number of illness categories based on Cumulative Illness Rating Scale Geriatrics for comorbidities. Multiple regression analyses identified the association between PSMS score as the dependent variable and other variables as independent variables. RESULTS In participants with severe dementia, the PSMS scores at baseline were significantly associated with CTSD, CCI, MNA-SF, and CSDD scores. In the longitudinal analysis, only CTSD score was significantly associated with PSMS score after 6 months. It is noteworthy that for participants with severe dementia, the only factor associated with ADL after 6 months was cognitive function, as assessed by CTSD score. CONCLUSIONS The most important factor predicting functional decline is cognitive function, even at the severe and profound stage.
Collapse
Affiliation(s)
- Hiroyuki Tanaka
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
| | - Yuma Nagata
- Department of Psychiatry, Course of Integrated Medicine, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Daiki Ishimaru
- Department of Psychiatry, Course of Integrated Medicine, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasuhiro Ogawa
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
| | - Keita Fukuhara
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
| | - Takashi Nishikawa
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
| |
Collapse
|
3
|
Mini Nutritional Assessment Score as a Potential Predictor of Pressure Ulcers in Elderly Nursing Home Patients With Dementia. TOP CLIN NUTR 2020. [DOI: 10.1097/tin.0000000000000195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
4
|
Doorduijn AS, de van der Schueren MAE, van de Rest O, de Leeuw FA, Fieldhouse JLP, Kester MI, Teunissen CE, Scheltens P, van der Flier WM, Visser M, Boesveldt S. Olfactory and gustatory functioning and food preferences of patients with Alzheimer's disease and mild cognitive impairment compared to controls: the NUDAD project. J Neurol 2019; 267:144-152. [PMID: 31595376 PMCID: PMC6954901 DOI: 10.1007/s00415-019-09561-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/16/2019] [Accepted: 09/26/2019] [Indexed: 11/16/2022]
Abstract
Our aim is to compare olfactory and gustatory function and food preferences of patients with Mild Cognitive Impairment (MCI) and Alzheimer’s disease (AD) with controls. We included 22 patients with MCI, 30 patients with AD and 40 controls and assessed olfactory threshold, odor discrimination and odor identification (Sniffin’ Sticks), gustatory functioning (Taste Strips), and food preferences (Macronutrient and Taste Preference Ranking Task). Linear regression analyses were used to study associations of five cognitive domains or AD biomarkers with olfactory functioning. Groups did not differ in olfactory threshold, gustatory function and food preferences. Patients with MCI and AD scored lower on odor discrimination and identification than controls. Poorer memory, but no other cognitive domain, was associated with poorer odor discrimination and odor identification, but not with odor threshold. No associations with AD biomarkers were found. In conclusion, patients with MCI and AD have poorer odor discrimination and identification ability than controls, but similar detection thresholds. This is likely a consequence of poorer memory rather than directly caused by AD pathology.
Collapse
Affiliation(s)
- A S Doorduijn
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
| | - M A E de van der Schueren
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.,Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - O van de Rest
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - F A de Leeuw
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - J L P Fieldhouse
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - M I Kester
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - C E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - P Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - W M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - M Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam and The Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S Boesveldt
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| |
Collapse
|
5
|
Associations of AD Biomarkers and Cognitive Performance with Nutritional Status: The NUDAD Project. Nutrients 2019; 11:nu11051161. [PMID: 31126170 PMCID: PMC6566264 DOI: 10.3390/nu11051161] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/15/2019] [Accepted: 05/21/2019] [Indexed: 11/17/2022] Open
Abstract
As malnutrition is common in patients with Alzheimer’s disease (AD), we evaluated nutritional status and body composition of patients with AD, mild cognitive impairment (MCI) and controls, and studied associations of AD biomarkers and cognitive performance with nutritional status and body composition. We included 552 participants, of which 198 patients had AD, 135 patients had MCI and 219 controls. We assessed nutritional status (mini nutritional assessment (MNA)) and body composition (body mass index (BMI), fat-free mass (FFM) and waist circumference). Linear regression analyses (adjusted for age, gender and education where appropriate) were applied to test associations of AD biomarkers and cognitive performance on five domains with nutritional parameters (dependent). Patients with MCI and AD had a lower BMI and MNA score than controls. Worse performance in all cognitive domains was associated with lower MNA score, but not with body composition. AD biomarkers were associated with MNA score, BMI and waist circumference, and associations with MNA score remained after adjustment for cognitive performance. Both AD biomarkers and cognitive performance were associated with nutritional status, associations with AD biomarkers remained after adjustment for cognition. Our data suggest that malnutrition is not only related to impaired cognition but also to AD pathology.
Collapse
|
6
|
Jang JW, Kim Y, Choi YH, Lee JM, Yoon B, Park KW, Kim SE, Kim HJ, Yoon SJ, Jeong JH, Kim EJ, Jung NY, Hwang J, Kang JH, Hong JY, Choi SH. Association of Nutritional Status with Cognitive Stage in the Elderly Korean Population: The Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's Disease. J Clin Neurol 2019; 15:292-300. [PMID: 31286699 PMCID: PMC6620466 DOI: 10.3988/jcn.2019.15.3.292] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/15/2018] [Accepted: 12/18/2018] [Indexed: 01/08/2023] Open
Abstract
Background and Purpose Epidemiological studies have suggested the presence of strong correlations among diet, lifestyle, and dementia onset. However, these studies have unfortunately had major limitations due to their inability to fully control the various potential confounders affecting the nutritional status. The purpose of the current study was to determine the nutritional status of participants in the Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's Disease (KBASE) and to identify clinical risk factors for being at risk of malnutrition or being malnourished. Methods Baseline data from 212 participants [119 cognitively unimpaired (CU), 56 with mild cognitive impairment (MCI), and 37 with dementia] included in the KBASE database were analyzed. All participants underwent a comprehensive cognitive test and MRI at baseline. The presence of malnutrition at baseline was measured by the Mini Nutritional Assessment score. We examined the cross-sectional relationships of clinical findings with nutritional status using multiple logistic regression applied to variables for which p<0.2 in the univariate analysis. Differences in cortical thickness according to the nutritional status were also investigated. Results After adjustment for demographic, nutritional, and neuropsychological factors, participants with dementia had a significantly higher odds ratio (OR) for being at risk of malnutrition or being malnourished than CU participants [OR=5.98, 95% CI=1.20–32.97] whereas participants with MCI did not (OR=0.62, 95% CI=0.20–1.83). Cortical thinning in the at-risk/malnutrition group was observed in the left temporal area. Conclusions Dementia was found to be an independent predictor for the risk of malnutrition compared with CU participants. Our findings further suggest that cortical thinning in left temporal regions is related to the nutritional status.
Collapse
Affiliation(s)
- Jae Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Yeshin Kim
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Yong Ho Choi
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Jong Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Bora Yoon
- Department of Neurology, Konyang University College of Medicine, Daejeon, Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Si Eun Kim
- Department of Neurology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Jin Yoon
- Department of Neurology, Eulji University College of Medicine, Daejeon, Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Eun Joo Kim
- Department of Neurology, Pusan National University School of Medicine, Busan, Korea
| | - Na Yeon Jung
- Department of Neurology, Pusan National University School of Medicine, Busan, Korea
| | - Jihye Hwang
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Ju Hee Kang
- Department of Pharmacology and Medicinal Toxicology Research Center, Inha University School of Medicine, Incheon, Korea
| | - Jin Yong Hong
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Korea.
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Korea.
| |
Collapse
|
7
|
Brangier A, Celle S, Roche F, Beauchet O, Ferland G, Annweiler C. Use of Vitamin K Antagonists and Brain Morphological Changes in Older Adults: An Exposed/Unexposed Voxel-Based Morphometric Study. Dement Geriatr Cogn Disord 2018; 45:18-26. [PMID: 29486479 DOI: 10.1159/000485793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/24/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Vitamin K antagonists (VKAs) are commonly used for their role in haemostasis by interfering with the vitamin K cycle. Since vitamin K also participates in brain physiology, this voxel-based morphometric study aimed to determine whether the duration of exposure to VKAs correlated with focal brain volume reduction in older adults. METHODS In this exposed/unexposed (1: 2) study nested within the GAIT (Gait and Alzheimer Interactions Tracking) cohort, 18 participants exposed to VKA (mean age 75 ± 5 years; 33.3% female; mean exposure 2,122 ± 1,799 days) and 36 matched participants using no VKA (mean age 75 ± 5 years; 33.3% female) underwent MRI scanning of the brain. Cortical grey and white matter volumes were automatically segmented using statistical parametric mapping. Age, gender, educational level, history of atrial fibrillation, type of MRI, and total intracranial volume were included as covariables. RESULTS The duration of exposure to VKA correlated inversely across the whole brain with the subvolumes of two clusters in the grey matter (right frontal inferior operculum and right precuneus) and one cluster in the white matter (left middle frontal gyrus). In contrast, the grade of white matter hyperintensities did not differ according to the use of VKA. CONCLUSION We found focal atrophies in older adults exposed to VKA. These findings provide new insights elucidating the effects of VKAs on brain health and function in older adults.
Collapse
Affiliation(s)
- Antoine Brangier
- Department of Geriatric Medicine and Memory Clinic, Angers University Hospital, UPRES EA 4638, University of Angers, Angers, France
| | - Sébastien Celle
- Service de Physiologie Clinique et de l'Exercice, CHU Saint-Etienne, Saint-Etienne, France.,EA 4607 "SNA EPIS" Faculté de Médecine J. Lisfranc UJM, PRES Université de Lyon, Lyon, France
| | - Frédéric Roche
- Service de Physiologie Clinique et de l'Exercice, CHU Saint-Etienne, Saint-Etienne, France.,EA 4607 "SNA EPIS" Faculté de Médecine J. Lisfranc UJM, PRES Université de Lyon, Lyon, France
| | - Olivier Beauchet
- Division of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Québec, Canada
| | - Guylaine Ferland
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, Québec, Canada
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Angers University Hospital, UPRES EA 4638, University of Angers, Angers, France.,Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
| |
Collapse
|
8
|
Lindquist LA, Ramirez-Zohfeld V, Sunkara PD, Forcucci C, Campbell DS, Mitzen P, Ciolino JD, Gregory D, Kricke G, Cameron KA. PlanYourLifeSpan.org - an intervention to help seniors make choices for their fourth quarter of life: Results from the randomized clinical trial. PATIENT EDUCATION AND COUNSELING 2017; 100:1996-2004. [PMID: 28689855 PMCID: PMC6065258 DOI: 10.1016/j.pec.2017.06.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 06/19/2017] [Accepted: 06/24/2017] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Few older adults contemplate their home support and health needs that may be required for aging-in-place. We sought to assess the efficacy of PlanYourLifespan.org (PYL), in influencing seniors' planning behaviors, perception of the importance of planning, and confidence accessing services. METHOD Randomized controlled trial, of adults, age ≥65 years in urban, suburban, rural areas of Texas, Illinois, Indiana. RESULTS Among 385 participants, mean age was 71.9 years, 79.5% female. Between baseline and one-month follow-up, average planning behavior score increased 0.22 points in the PYL arm when compared to the attention control (AC) arm. After controlling for baseline, mean one-month planning behavior score was significantly higher in the PYL arm than in the AC arm (1.25 points, CI 0.37-2.12, p=0.005). Secondary analyses via longitudinal linear mixed modelling suggested a study arm-by-time interaction effect for both planning behavior (p=0.047 and perception of importance (p=0.05). Significant baseline covariates included self-efficacy, education, perceived social support, power of attorney, and history of stroke. CONCLUSIONS AND PRACTICE IMPLICATIONS PlanYourLifespan.org demonstrated efficacy in helping seniors plan for and communicate their health support needs. This free, nationally available tool may help individuals understand, plan, and communicate their options for their future support needs.
Collapse
Affiliation(s)
- Lee A Lindquist
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL,USA.
| | - Vanessa Ramirez-Zohfeld
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL,USA
| | - Priya D Sunkara
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL,USA
| | - Chris Forcucci
- Aging and In-Home Services of Northeast Indiana, Fort Wayne, IN, USA
| | | | | | - Jody D Ciolino
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL,USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dyanna Gregory
- Division of Gastroenterology-Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gayle Kricke
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Kenzie A Cameron
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL,USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
9
|
Franx BAA, Arnoldussen IAC, Kiliaan AJ, Gustafson DR. Weight Loss in Patients with Dementia: Considering the Potential Impact of Pharmacotherapy. Drugs Aging 2017; 34:425-436. [PMID: 28478593 DOI: 10.1007/s40266-017-0462-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Unintentional body weight loss is common in patients with dementia and is linked to cognitive impairment and poorer disease outcomes. It is proposed that some dementia medications with market approval, while aiming to improve cognitive and functional outcomes of a patient with dementia, are associated with reported body weight or body mass index loss. This review presents evidence in the published literature on body weight loss in dementia, describes selected theories behind body weight loss, evaluates the potential impact of approved dementia pharmacotherapies on body weight, considers the potential role for medical foods, understands the potential influence of treatments for neuropsychiatric symptoms and signs, and finally, summarizes this important area.
Collapse
Affiliation(s)
- Bart A A Franx
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilse A C Arnoldussen
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Amanda J Kiliaan
- Department of Anatomy, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Deborah R Gustafson
- Department of Neurology, Section for NeuroEpidemiology, State University of New York, Downstate Medical Center, 450 Clarkson Avenue, Box 1213, Brooklyn, NY, 11203, USA. .,Neuropsychiatric Epidemiology Unit (EPINEP), Institute for Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. .,Department of Health and Education, University of Skövde, Skövde, Sweden.
| |
Collapse
|
10
|
Keser A, Yildirim F. Evaluation of the Relationship between Nutritional Status and Quality of Life among Nursing Home Residents with Alzheimer's Disease. ADVANCES IN PSYCHOLOGY, MENTAL HEALTH, AND BEHAVIORAL STUDIES 2016. [DOI: 10.4018/978-1-5225-0925-7.ch003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The purpose of this study was to determine nutritional status and its influence on their quality of life in Alzheimer's disease (AD) patients with Mini Nutritional Assessment (MNA) and anthropometric measurements. This study was conducted with 57 Alzheimer type dementia patients between the ages of 52 and 89 who live in nursing homes in Ankara/Turkey. In this study, it was found that the 57.9% of the AD patients were at risk of malnutrition, and that 19.3% were malnourished. Malnutrition risk rises as the length of stay increases (p< .05). A significant correlation between body weight and quality of life as well as one between calf circumference and quality of life was detected (p< .05). In this study, nutrient intake among aged individuals with AD was found unbalanced; a statistically significant correlation between energy / nutrient intake and quality of life also was not detected.
Collapse
|
11
|
|
12
|
Droogsma E, van Asselt D, De Deyn PP. Weight loss and undernutrition in community-dwelling patients with Alzheimer’s dementia. Z Gerontol Geriatr 2015; 48:318-24. [DOI: 10.1007/s00391-015-0891-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 03/14/2015] [Accepted: 04/01/2015] [Indexed: 11/30/2022]
|
13
|
Vahabi M, Schindel Martin L. Food security: who is being excluded? A case of older people with dementia in long-term care homes. J Nutr Health Aging 2014; 18:685-91. [PMID: 25226107 DOI: 10.1007/s12603-014-0501-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES PURPOSE To explore the extent of food security among older people, particularly those with cognitive impairments residing in Canadian long-term care homes (LTCHs) through a focused review of literature. METHOD Databases including Medline, Nursing and Health Sciences (SAGE), Psych Info, Social Sciences Abstract, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and HealthSTAR were searched for peer-reviewed articles related to food experiences of older individuals in industrialized countries including Canada. Only articles that were published in English between 1997-2012 were included. RESULTS Sixty two studies met the inclusion criteria. Of those 17 focused on older adults in LTCHs. The review found that food security has rarely been examined among older persons living in LTCHs, and has never been examined within the context of cognitive impairment. While a few studies have focused on residents' satisfaction with foods that are provided to them in LTCHs, none have explored the extent of food security in this population. Furthermore, food satisfaction surveys in the LTCH are limited to the assessment of foods that are served to residents, and do not capture residents' food accessibility beyond the food dispensing routines of the organization. Thus, food quality, food preferences, and the traditional meanings and rituals associated with food consumption are not purposefully evaluated. In addition, LTCHs are not required to monitor residents' food satisfaction using a consistent, regular, and standardized approach and there is no regulation in the LTCH Act that requires LTCHs to assess their residents' food security. CONCLUSIONS The findings highlight the need for: 1) expansion of food security research to non-community-based settings including LTCHs; 2) re-conceptualization of food security and modification of measurement tools to assess the extent and determinants of food security among older adults in LTCHs; 3) mandatory monitoring of food security via standardized and regular surveys tailored to meet the unique preferences and needs of the older population, particularly those with dementia; and 4) education of healthcare professionals regarding food security and its assessment in LTCHs.
Collapse
Affiliation(s)
- M Vahabi
- Mandana Vahabi, Ph.D., Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Telephone: (416) 979-5000, Ext. 2725, Fax Number: (416) 979-5332, E-mail address:
| | | |
Collapse
|
14
|
Droogsma E, van Asselt D, van Steijn J, Veeger N, van Dusseldorp I, De Deyn PP. Nutritional interventions in community-dwelling Alzheimer patients with (risk of) undernutrition: a systematic review. Int Psychogeriatr 2014; 26:1-9. [PMID: 24846712 DOI: 10.1017/s1041610214000817] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT Background: Weight loss and undernutrition are common in patients with Alzheimer's disease (AD) and associated with negative health outcomes. In the current guidelines on diagnosis and treatment of AD, no recommendations for treatment of (risk of) undernutrition in community-dwelling AD patients are given. Methods: We conducted a systematic review on the effect of nutritional interventions in community-dwelling AD patients with (risk of) undernutrition, according to the methods outlined by the Cochrane Collaboration. Three electronic databases and three trial registers were searched from inception till April 2013. Results: Literature search in the electronic databases yielded 546 records of which one was relevant for this review. This study, with a high risk of bias, demonstrated that oral nutritional supplements improved nutritional outcomes without effect on clinical and biochemical outcomes. The search in the trial registers yielded 369 records of which two were relevant. One trial was terminated because of failing inclusion, the other is ongoing. Conclusions: This systematic review on the effect of nutritional interventions in community-dwelling AD patients with (risk of) undernutrition, reveals a serious lack of evidence. Therefore, it is not possible to state what the best approach is.
Collapse
Affiliation(s)
- Erika Droogsma
- Department of Geriatric Medicine,Medical Center Leeuwarden,Leeuwarden,the Netherlands
| | - Dieneke van Asselt
- Department of Geriatric Medicine,Medical Center Leeuwarden,Leeuwarden,the Netherlands
| | - Jolanda van Steijn
- Department of Geriatric Medicine,Medical Center Leeuwarden,Leeuwarden,the Netherlands
| | - Nic Veeger
- Department of Epidemiology,Medical Center Leeuwarden,Leeuwarden,the Netherlands
| | | | - Peter Paul De Deyn
- Department of Neurology and Alzheimer Research Center,University Medical Center Groningen,University of Groningen,Groningen,the Netherlands
| |
Collapse
|
15
|
|
16
|
Droogsma E, van Asselt DZB, Schölzel-Dorenbos CJM, van Steijn JHM, van Walderveen PE, van der Hooft CS. Nutritional status of community-dwelling elderly with newly diagnosed Alzheimer's disease: prevalence of malnutrition and the relation of various factors to nutritional status. J Nutr Health Aging 2013; 17:606-10. [PMID: 23933871 DOI: 10.1007/s12603-013-0032-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To determine the prevalence of malnutrition and its relation to various factors in community-dwelling elderly with newly diagnosed Alzheimer's disease (AD). DESIGN Retrospective cross-sectional study. SETTING Memory clinic in a rural part of the Netherlands. PARTICIPANTS 312 Community-dwelling AD patients, aged 65 years or older, were included. MEASUREMENTS At the time the diagnosis AD was made, socio-demographic characteristics and data on nutritional status (Mini Nutritional Assessment (MNA)), cognitive function (Mini Mental State Examination (MMSE), Cambridge Cognitive Examination (Camcog)), functional status (Interview for Deterioration in Daily Living Activities in Dementia (IDDD), Barthel Index (BI)) and behaviour (Revised Memory and Behaviour Problems Checklist (RMBPC)) were assessed. Characteristics of well-nourished patients (MNA score >23.5) were compared to characteristics of patients at risk of malnutrition (MNA score 17-23.5). Linear regression analysis was performed to assess the effect of various factors on nutritional status. RESULTS The prevalence of malnutrition was 0% and 14.1% was at risk of malnutrition. AD patients at risk of malnutrition were more impaired in basic and complex daily functioning than well-nourished AD patients (median IDDD score 41.5 [25th -75th percentile 38.8-48.0] versus median IDDD score 40.0 [25th -75th percentile 37.0-43.0], p = 0.028). The degree of impairment in basic and complex daily functioning (IDDD) was independently related to nutritional status (MNA) (p = 0.001, B = -0.062). CONCLUSION One in seven community-dwelling elderly with newly diagnosed AD is at risk of malnutrition. The degree of impairment in daily functioning is independently related to nutritional status. Therefore, assessment of the nutritional status should be included in the comprehensive assessment of AD patients. The relation between daily functioning, nutritional status and AD warrants further investigation.
Collapse
Affiliation(s)
- E Droogsma
- Geriatric Medicine, Medical Centre Leeuwarden, Po Box 888 Leeuwarden 8901 BR, The Netherlands
| | | | | | | | | | | |
Collapse
|
17
|
Pivi GAK, Bertolucci PHF, Schultz RR. Nutrition in severe dementia. Curr Gerontol Geriatr Res 2012; 2012:983056. [PMID: 22645608 PMCID: PMC3356862 DOI: 10.1155/2012/983056] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 02/18/2012] [Accepted: 02/21/2012] [Indexed: 11/17/2022] Open
Abstract
An increasing proportion of older adults with Alzheimer's disease or other dementias are now surviving to more advanced stages of the illness. Advanced dementia is associated with feeding problems, including difficulty in swallowing and respiratory diseases. Patients become incompetent to make decisions. As a result, complex situations may arise in which physicians and families decide whether artificial nutrition and hydration (ANH) is likely to be beneficial for the patient. The objective of this paper is to present methods for evaluating the nutritional status of patients with severe dementia as well as measures for the treatment of nutritional disorders, the use of vitamin and mineral supplementation, and indications for ANH and pharmacological therapy.
Collapse
Affiliation(s)
| | | | - Rodrigo Rizek Schultz
- Behavior Neurology Section, Federal University of São Paulo (UNIFESP), 04025-000 São Paulo SP, Brazil
| |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW To summarize recent evidences and advances on the implementation and the use of the Mini Nutritional Assessment (MNA). RECENT FINDINGS Despite being introduced and validated for clinical use about 20 years ago, the MNA has recently received new attention in order to more widely disseminate among healthcare professionals the practice of a systematic nutritional screening and assessment of the old patient. Particularly, the structure has been implemented to face the difficulties in having the patients contributing to the assessment and to reduce further the time required to complete the evaluation. Recent data also confirm that in older populations prevalence of malnutrition by this tool is associated with the level of dependence. The rationale of nutritional assessment is to identify patients candidate to nutritional support. However, the sensitivity of the MNA is still debated because it has been associated with a high-risk 'overdiagnosis' and the advantages of a positive screening need to be assessed both in terms of outcome and money saving. SUMMARY The MNA is a simple and highly sensitive tool for nutritional screening and assessment. The large mass of data collected and the diffusion among healthcare professionals clearly support its use. However, the cost-effectiveness of interventions based on its scoring deserves investigation.
Collapse
Affiliation(s)
- Emanuele Cereda
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| |
Collapse
|
19
|
Koliaki CC, Messini C, Tsolaki M. Clinical efficacy of aniracetam, either as monotherapy or combined with cholinesterase inhibitors, in patients with cognitive impairment: a comparative open study. CNS Neurosci Ther 2011; 18:302-12. [PMID: 22070796 DOI: 10.1111/j.1755-5949.2010.00244.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Dementia constitutes an increasingly prevalent cognitive disorder with serious socioeconomic implications. AIMS In the present study, we aimed to evaluate the efficacy of aniracetam, either as monotherapy or combined with cholinesterase inhibitors (ChEIs), in terms of several neuropsychological parameters, in a considerable number of patients with dementia. RESULTS In our prospective, open-label study, we enrolled a total of 276 patients (mean age 71 ± 8 years, 95 males) with cognitive disorders. Our study population comprised four groups: no treatment group (n = 75), aniracetam monotherapy group (n = 58), ChEIs monotherapy group (n = 68), and group of combined treatment (n = 68). Patients were examined with validated neuropsychological tests at baseline, 3, 6, and 12 months of treatment. In patients treated with aniracetam, all studied parameters were adequately maintained at 6 and 12 months, while emotional state was significantly improved at 3 months. In patients treated with ChEIs, we observed a significant cognitive deterioration at 12 months. The comparison between aniracetam and ChEIs in patients with relatively mild dementia (15 ≤ MMSE ≤ 25) revealed a significantly better cognitive performance with aniracetam at 6 months and improved functionality at 3 months. Comparing aniracetam monotherapy with combined treatment in the same population, aniracetam performed better in the cognitive scale at 6 months, and displayed a notable tendency for enhanced mood at 12 months and improved functionality at 6 months. CONCLUSIONS Our findings indicate that aniracetam (a nootropic compound with glutamatergic activity and neuroprotective potential) is a promising option for patients with cognitive deficit of mild severity. It preserved all neuropsychological parameters for at least 12 months, and seemed to exert a favorable effect on emotional stability of demented patients.
Collapse
Affiliation(s)
- Chrysi C Koliaki
- Third Department of Neurology, Aristotle University of Thessaloniki, General Hospital G. Papanikolaou, Exohi, Thessaloniki, Greece.
| | | | | |
Collapse
|
20
|
In brief. Nat Rev Neurol 2010. [DOI: 10.1038/nrneurol.2009.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|