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Labyak C, Sealey-Potts C, Wright L, Kriek C, Dilts S. Informal caregiver and healthcare professional perspectives on dementia and nutrition. J Hum Nutr Diet 2024. [PMID: 38935854 DOI: 10.1111/jhn.13344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/08/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Persons living with dementia and informal caregivers are at a higher risk for malnutrition. Most caregivers are not experts at identifying nutritional complications of dementia. Therefore, we aimed to identify nutrition knowledge and challenges related to feeding and caring for persons with dementia to develop a meaningful intervention. METHODS A mixed-methods approach was used. Eight focus groups were conducted with caregivers of persons living with dementia (n = 28) and healthcare professionals (n = 23). Data was analysed using NVivo software. A questionnaire was administered to identify nutritional challenges. A modified food frequency questionnaire assessed food patterns of caregivers and persons with dementia. Results were compared to Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) dietary guidelines. Data were analysed using SPSS software. RESULTS Four major themes emerged: forgetting to eat, developing food aversions, strong preferences for sweets and weight changes. Findings revealed common strategies used to improve nutrition intake included cueing, supplements and quiet eating environment. Caregivers were impacted by stress leading to poorer food choices and exhaustion. Recommendations for a caregiver program made by participants included education, resources and support. Findings from the food frequencies questionnaire survey showed most participants had a lower dietary diversity compared to the MIND diet guidelines. CONCLUSIONS With both groups being more prone to malnutrition, this research shows that participants were less likely to obtain adequate nutrition for brain health. Additionally, caregivers are dealing with nutrition issues themselves and their person living with dementia. The findings support the need for registered dietitians to provide tailored nutrition interventions for these families.
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Affiliation(s)
- Corinne Labyak
- Department of Nutrition and Dietetics, University of North Florida, Jacksonville, FL, USA
| | - Claudia Sealey-Potts
- Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, TX, USA
| | - Lauri Wright
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Crystal Kriek
- Department of Nutrition and Dietetics, University of North Florida, Jacksonville, FL, USA
| | - Stephenie Dilts
- Department of Nutrition and Dietetics, University of North Florida, Jacksonville, FL, USA
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2
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Morrow CB, Leoutsakos J, Yan H, Onyike C, Kamath V. Weight Change and Neuropsychiatric Symptoms in Alzheimer's Disease and Frontotemporal Dementia: Associations with Cognitive Decline. J Alzheimers Dis Rep 2023; 7:767-774. [PMID: 37662607 PMCID: PMC10473120 DOI: 10.3233/adr-230034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/29/2023] [Indexed: 09/05/2023] Open
Abstract
Weight changes, neuropsychiatric symptoms (NPS), and cognitive decline often coincide in Alzheimer's disease (AD) and frontotemporal dementia (FTD); however, the direction of their relationship remains unclear. This study aims to clarify the connection between weight changes, NPS, and cognition in AD and FTD. We found that cognitive decline was associated with decreased body mass index (BMI) in AD, while BMI gain was associated with increased conversion to FTD. Elevated NPS were associated with decreased BMI in AD and increased BMI in FTD. Identifying early changes in NPS and BMI may facilitate the detection of cognitive decline, providing an opportunity for early intervention.
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Affiliation(s)
- Christopher B. Morrow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jeannie Leoutsakos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Haijuan Yan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Chiadi Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Vidyulata Kamath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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3
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El Osta N, Wehbe A, Sleiman N, Drancourt N, El Osta L, Hennequin M. Dental Criteria Could Alert for Malnutrition Risk and Inappropriate Choice of Food Texture in Older Subjects with Dementia: An Analytical Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15086. [PMID: 36429816 PMCID: PMC9690132 DOI: 10.3390/ijerph192215086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 06/16/2023]
Abstract
Oral health indicators are usually collected to alert for the presence of infectious diseases, but the impact of poor oral health on the nutritional status of older people with dementia is often neglected. This study aims to explore the relationship between the number of posterior dental functional units (PFUs) and the anthropometric measure of malnutrition, the mid-upper arm circumference (MUAC), in older people with dementia while controlling for other variables, and to analyze whether the number of PFUs is considered when adjusting the texture of the food provided at mealtimes. A total of 103 individuals who were 70 years or older with dementia were recruited from seven institutions. Cognitive impairment was assessed using the Mini Mental State Examination. Data were collected from medical records (sociodemographic characteristics, presence of chronic diseases, prescribed medications, results of serum albumin level), as well as questionnaires (type of feeding routes, type of food texture, supplements intake, Activity of Daily Living index), clinical examinations (MUAC), and oral health parameters (PFUs, oral dryness, oral hygiene). MUAC was the dependent outcome variable. MUAC was associated with the number of PFUs (p = 0.032); participants with PFU ≤ 4 were 7.5 times more likely to have MUAC < 21 cm than others. Other associations were found between MUAC and albumin level (OR = 12.5; p = 0.001), modified food texture (OR = 4.2; p = 0.035), and length of institutional stay (OR = 5.2; p = 0.033); however, the type of oral feeding was not significantly related to the number of PFUs (p = 0.487) so there is an inadequate correlation between food texture and oral health status. Similar to MUAC, the number of PFUs could be an oral anthropometric criterion that is recorded during routine hygiene care to alert for the risk of malnutrition and the inappropriate choice of food texture in older individuals with dementia.
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Affiliation(s)
- Nada El Osta
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, 63000 Clermont-Ferrand, France
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut 111, Lebanon
| | - Amine Wehbe
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut 111, Lebanon
| | - Nelly Sleiman
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut 111, Lebanon
| | - Noemie Drancourt
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, 63000 Clermont-Ferrand, France
- CHU of Clermont-Ferrand, Service d’Odontologie, 63003 Clermont-Ferrand, France
| | - Lana El Osta
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut 111, Lebanon
| | - Martine Hennequin
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, 63000 Clermont-Ferrand, France
- CHU of Clermont-Ferrand, Service d’Odontologie, 63003 Clermont-Ferrand, France
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4
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Bianchi VE, Rizzi L, Somaa F. The role of nutrition on Parkinson's disease: a systematic review. Nutr Neurosci 2022; 26:605-628. [PMID: 35730414 DOI: 10.1080/1028415x.2022.2073107] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Parkinson's disease (PD) in elderly patients is the second most prevalent neurodegenerative disease. The pathogenesis of PD is associated with dopaminergic neuron degeneration of the substantia nigra in the basal ganglia, causing classic motor symptoms. Oxidative stress, mitochondrial dysfunction, and neuroinflammation have been identified as possible pathways in laboratory investigations. Nutrition, a potentially versatile factor from all environmental factors affecting PD, has received intense research scrutiny. METHODS A systematic search was conducted in the MEDLINE, EMBASE, and WEB OF SCIENCE databases from 2000 until the present. Only randomized clinical trials (RCTs), observational case-control studies, and follow-up studies were included. RESULTS We retrieved fifty-two studies that met the inclusion criteria. Most selected studies investigated the effects of malnutrition and the Mediterranean diet (MeDiet) on PD incidence and progression. Other investigations contributed evidence on the critical role of microbiota, vitamins, polyphenols, dairy products, coffee, and alcohol intake. CONCLUSIONS There are still many concerns regarding the association between PD and nutrition, possibly due to underlying genetic and environmental factors. However, there is a body of evidence revealing that correcting malnutrition, gut microbiota, and following the MeDiet reduced the onset of PD and reduced clinical progression. Other factors, such as polyphenols, polyunsaturated fatty acids, and coffee intake, can have a potential protective effect. Conversely, milk and its accessory products can increase PD risk. Nutritional intervention is essential for neurologists to improve clinical outcomes and reduce the disease progression of PD.
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Affiliation(s)
| | - Laura Rizzi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Fahad Somaa
- King Abdulaziz University, Department of occupational therapy. Jeddah, Makkah, Saudi Arabia
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5
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Lee YG, Park M, Jeong SH, Kang SW, Baik K, Jung JH, Lee PH, Sohn YH, Ye BS. Effects of baseline serum uric acid and apolipoprotein E4 on longitudinal cognition and cerebral metabolism. Neurobiol Aging 2021; 106:223-231. [PMID: 34311431 DOI: 10.1016/j.neurobiolaging.2021.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 12/20/2022]
Abstract
Serum uric acid, a natural antioxidant, may have a protective effect on the progression of Alzheimer's disease (AD). To investigate the effect of serum uric acid on longitudinal cognitive and brain metabolic changes, we utilized data on baseline serum uric acid levels, APOE genotyping, and longitudinal cognitive scores from the Alzheimer's Disease Neuroimaging Initiative for 1,343 participants with normal cognition (NC), mild cognitive impairment (MCI), or dementia. In 979 participants, brain metabolism was measured using 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) images. Higher serum uric acid levels exhibited a detrimental effect on NC, whereas a protective trend was observed in individuals with cognitive impairment. Interestingly, higher uric acid levels were associated with a slower decline in cognitive scores and brain metabolism in females with MCI, and this effect was found in APOE4 carriers, but not in non-carriers. Longitudinal AD-like patterns of brain metabolism on FDG-PET images also appeared to mediate the effects of baseline uric acid levels on longitudinal cognitive decline. In summary, higher serum uric acid may interact with APOE4 to alleviate longitudinal metabolic changes and cognitive decline in female MCI patients.
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Affiliation(s)
- Young-Gun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mincheol Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Ho Jeong
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Sung Woo Kang
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Ho Jung
- Department of Neurology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byoung Seok Ye
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea.
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6
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Chen TB, Weng SC, Chou YY, Lee YS, Liang CK, Lin CS, Lan TH, Lin SY, Lin YT. Predictors of Mortality in the Oldest Old Patients with Newly Diagnosed Alzheimer Disease in a Residential Aged Care Facility. Dement Geriatr Cogn Disord 2020; 48:93-104. [PMID: 31600747 DOI: 10.1159/000503059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/01/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Taiwan, the causes of death and related factors in the oldest old people with Alzheimer disease (AD) are not well characterized. We investigated the factors associated with mortality in the oldest old patients with newly diagnosed AD admitted to a long-stay residential facility. METHODS We performed a prospective study of newly diagnosed AD patients at a veterans' home between 2012 and 2016. At admission, all eligible participants received a comprehensive geriatric assessment, including demographic variables, lifestyle habits, cognitive evaluations, medical conditions (comorbidities, Age-Adjusted Charlson Comorbidity Index score, and polypharmacy), nutritional status evaluated by the Mini Nutritional Assessment-Short Form and body mass index (BMI), and global functional status. A Cox proportional hazards model was used to evaluate the predictive values of clinical parameters for all-cause mortality. RESULTS The cohort comprised 84 newly diagnosed AD patients (mean age 86.6 ± 3.9 years) with a mean follow-up period of 2.1 ± 1.2 years. The overall median survival was 3.5 years from the time of AD diagnosis (95% confidence interval, 3.1-3.9 years). BMI was significantly lower in the deceased group than in the alive group (20.7 ± 2.9 vs. 22.6 ± 3.4, p = 0.023). Logistic regression demonstrated that the clinical parameters significantly associated with mortality were high global comorbidity, low nutritional status (malnutrition and underweight), and impaired physical function at the time of AD diagnosis. CONCLUSION Comorbidity burden, nutritional status, and physical functional status at the time of dementia diagnosis are important contributors to poor outcome in the oldest old. Efforts to control concurrent chronic disorders, nutritional interventions, and physical independency as a long-term care strategy for dementia may provide survival benefit.
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Affiliation(s)
- Ting-Bin Chen
- Department of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shuo-Chun Weng
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Yin Chou
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Shan Lee
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chih-Kaung Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chu-Sheng Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsuo-Hung Lan
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan
| | - Shih-Yi Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan,
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7
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Predictors of Discontinuance of Oral Feeding in Patients With Advanced Alzheimer Dementia and Aspiration Pneumonia in Japan: A Single-center, Retrospective Observational Study. Alzheimer Dis Assoc Disord 2019; 33:339-345. [PMID: 31136305 PMCID: PMC6882538 DOI: 10.1097/wad.0000000000000316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Difficulty with oral feeding, the most commonly observed complication of Alzheimer disease (AD) in its final stages, occurs in 86% of AD patients and may prevent achievement of oral feeding after aspiration pneumonia. However, no reliable indicators of discontinuance of oral feeding have yet been identified. We therefore aimed to identify predictors of discontinuance of oral feeding in postaspiration pneumonia patients with AD. MATERIALS AND METHODS Relevant clinical and laboratory data of 60 patients with AD admitted to our hospital in Japan for aspiration pneumonia were retrospectively compared between oral feeding and discontinuance groups. RESULTS The study groups differed in interval since diagnosis of AD, CURB-65 score, pneumonia severity index score, and proportion of patients who died (higher in the discontinuance group) and body mass index (BMI), Mini Mental State Examination (MMSE) score, and functional independence measure score (lower in the discontinuance group). According to multivariate logistic regression analysis of all identified independent variables, only CURB-65 and MMSE scores and BMI are significant predictors of discontinuance of oral feeding after aspiration pneumonia in patients with advanced AD. CONCLUSIONS In patients with advanced AD, discontinuance of oral feeding after aspiration pneumonia may be predicted by CURB-65 and MMSE scores and BMI.
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8
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Jeon JH, Park JH, Oh C, Chung JK, Song JY, Kim S, Lee SH, Jang JW, Kim YJ. Dementia is Associated with an Increased Risk of Hip Fractures: A Nationwide Analysis in Korea. J Clin Neurol 2019; 15:243-249. [PMID: 30938111 PMCID: PMC6444145 DOI: 10.3988/jcn.2019.15.2.243] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 11/25/2022] Open
Abstract
Background and Purpose Dementia has been reported to be associated with an increased risk of hip fracture, but few case-control studies have been performed to actually confirm this. This study investigated the association between dementia and hip fracture by comparing the risk of hip fracture between subjects with and without dementia. Methods We examined a population-based matched cohort from the National Health Insurance Service-Senior Cohort data set that covers approximately half a million recipients of medical insurance in South Korea. Subjects with new clinically verified dementia during 2003–2007 were included, and five subjects without dementia were matched for age, sex, and index year to each subject with dementia as the controls. The risk of hip fracture for dementia was evaluated up to 2015 using Cox regression analysis. Results During the 12-year follow-up period, 284 subjects with dementia (10.66%) and 603 subjects without dementia (4.53%) experienced hip fractures. Dementia was independently associated with a higher risk of hip fracture [hazard ratio (HR)=2.840, 95% CI=2.449–3.293] and the adjusted HR for hip fracture in the subjects with dementia was highest within 2 years after the initial diagnosis (HR=2.862, 95% CI=2.053–3.990). Conclusions This study found that dementia could be an independent risk factor for hip fracture even at the early stage. This necessitates consideration of the future risk of falls and balance deficits in terms of physical activity after a diagnosis of dementia.
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Affiliation(s)
- Jae Hyuen Jeon
- Department of Statistics, Kangwon National University, Chuncheon, Korea
| | - Jeong Hoon Park
- Department of Neurology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Chungkun Oh
- Department of Neurology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Jae Kyung Chung
- Department of Neurology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Jeong Yun Song
- Department of Neurology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Seongheon Kim
- Department of Neurology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Seung Hwan Lee
- Department of Neurology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Jae Won Jang
- Department of Neurology, Kangwon National University School of Medicine, Kangwon National University Hospital, Chuncheon, Korea.
| | - Young Ju Kim
- Department of Statistics, Kangwon National University, Chuncheon, Korea.
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Salvato G, Mercurio M, Sberna M, Paulesu E, Bottini G. A very light lunch: Interoceptive deficits and food aversion at onset in a case of behavioral variant frontotemporal dementia. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2018; 10:750-754. [PMID: 30480080 PMCID: PMC6240841 DOI: 10.1016/j.dadm.2018.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Patients affected by the behavioral variant frontotemporal dementia (bvFTD) frequently experience, at a delayed onset, abnormal eating behavior involving increased food intake. Although delusional food-related symptoms have attracted much attention, the behavioral and neural features of food aversion manifestations in bvFTD remain poorly documented. Methods We describe the rare case of a patient with bvFTD presenting with lack of interoception for swallowing and digestion, coupled with a dramatic food aversion at onset. We also compared his MRI scan to 84 healthy individuals using a voxel-based morphometry approach. Results We found gray matter density reductions involving the postcentral gyrus bilaterally, insulae, and right medial orbitofrontal cortex. Discussion Our results shed new light on the behavioral and neuroanatomical features of food aversion and interoception deficits in bvFTD, suggesting that besides orbitofrontal cortex, also a distributed system associated with interoception might play a role in such behavioral manifestation.
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Affiliation(s)
- Gerardo Salvato
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Cognitive Neuropsychology Centre, ASST "Grande Ospedale Metropolitano" Niguarda, Milan, Italy.,NeuroMi, Milan Centre for Neuroscience, Milano, Italy
| | - Matteo Mercurio
- Neurodegenerative Disease Unit, Department of Pathophysiology and Transplantation, Centro Dino Ferrari, University of Milan, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Maurizio Sberna
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Eraldo Paulesu
- Department of Psychology, University of Milano-Bicocca, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Gabriella Bottini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Cognitive Neuropsychology Centre, ASST "Grande Ospedale Metropolitano" Niguarda, Milan, Italy.,NeuroMi, Milan Centre for Neuroscience, Milano, Italy
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Hsiao HT, Lee JJ, Chen HH, Wu MK, Huang CW, Chang YT, Lien CY, Wang JJ, Chang HI, Chang CC. Adequacy of nutrition and body weight in patients with early stage dementia: The cognition and aging study. Clin Nutr 2018; 38:2187-2194. [PMID: 30316533 DOI: 10.1016/j.clnu.2018.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 09/08/2018] [Accepted: 09/13/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIMS Recent evidence highlights the effects of obesity, diabetes and hypertension in the development of Alzheimer's disease. Involuntary body weight changes in patients with different stages of dementia can be related to clinical factors of the patient per se or support from their caregivers. Understanding the interactions among factors is important to establish a monitoring paradigm to guide treatment strategies. METHODS A total of 345 patients with very mild (n = 224) and mild stage (n = 121) dementia were enrolled from a multi-disciplinary dementia clinic. Clinical data (comorbidities, Mini-Mental State Examination [MMSE] scores, neuropsychiatric inventory [NPI] scores, eating behavior questionnaire), nutritional state (Mini-Nutritional Assessment [MNA] or MNA short form [MNA-SF]) and body mass index (BMI) were recorded. Nutritional state and BMI served as the two major outcome measures, and factors for analysis included diagnosis, dementia severity and clinical data. RESULTS There was a significant correlation between MNA-SF and MNA (r = .898, p < 0.01), but a 24% mismatch in case dislocation was found using the at-risk or malnutrition criteria. Factors related to obesity included male sex, higher MNA-SF and MNA scores, diabetes mellitus and hypertension, while acceptable discrimination for obesity (BMI≧23 kg/m2) was obtained with a MNA-SF score of 12/13 or MNA score of 21/22. NPI was the only independent factor related to both MNA-SF (β = -.06, P < 0.001) and MNA (β = -.1, P < 0.001). A BMI of 22-23 kg/m2 was adequate in this group of patients with early stage dementia from nutritional and comorbidity perspectives. After controlling for BMI, the patients with advanced dementia had higher swallowing problem and appetite change scores. CONCLUSIONS In these patients with early stage dementia, a higher BMI indicated adequate nutritional status and higher MMSE, but also higher rates of comorbidities, diabetes mellitus and hypertension.
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Affiliation(s)
- Hua-Tsen Hsiao
- Department of Nursing, National Tainan Junior College of Nursing, Taiwan
| | - Jun-Jun Lee
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsiu-Hui Chen
- Department of Physical Education, National Kaohsiung University of Science and Technology, Taiwan
| | - Ming-Kung Wu
- Department of Psychiatry, Cognition and Aging Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Wei Huang
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ya-Ting Chang
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Yi Lien
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jing-Jy Wang
- Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan
| | - Hsin-I Chang
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute of Human Resource Management, National Sun Yat-Sen University, Taiwan
| | - Chiung-Chih Chang
- Department of Neurology and Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Garre-Olmo J, Garcia-Ptacek S, Calvó-Perxas L, Turró-Garriga O, López-Pousa S, Eriksdotter M. Diagnosis of Dementia in the Specialist Setting: A Comparison Between the Swedish Dementia Registry (SveDem) and the Registry of Dementias of Girona (ReDeGi). J Alzheimers Dis 2018; 53:1341-51. [PMID: 27392854 PMCID: PMC5115613 DOI: 10.3233/jad-160098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The aim of this study was to compare the frequency of dementia diagnoses from two dementia registries in Europe. Patients registered between 2007 and 2013 in the Swedish Dementia Registry (SveDem; Sweden) and in the Registry of Dementias of Girona (ReDeGi; North-East of Spain) were selected. We compared sociodemographic data, Mini-Mental State Examination (MMSE) scores, dementia subtype, and medication consumption of 22,384 cases from SveDem and 5,032 cases from ReDeGi. The average age (78.1 years SveDem versus 79.7 years ReDeGi) and the gender (female 58.2% SveDem versus 61.5% ReDeGi) did not greatly differ. MMSE score at diagnosis was higher for SveDem cases (22.1 versus 17.8). Alzheimer’s disease (AD) accounted for the main dementia subtype (36.6% SveDem versus 55.6% ReDeGi). The proportion of vascular dementia (VaD) and mixed dementia was higher in SveDem (18.8% versus 6.4% and 24.9 versus 13.4%), with an odds ratio (OR) and 95% confidence interval (CI) for SveDem relative to the ReDeGi of 3.41 (3.03–3.84) for VaD, and 2.15 (1.97–2.35) for mixed dementia. This was at the expense of a lower frequency of AD in SveDem (OR 0.41; 95% CI 0.39–0.44). Other dementia diagnoses such as frontotemporal dementia or dementia with Lewy bodies did not significantly differ between registries (2.3% versus 2.9%; 1.9 versus 3.1%). Large differences in medication consumption at the time of dementia diagnosis were detected (4.7 treatments SveDem versus 6.8 ReDeGi). Northern and southern European dementia cohorts differ in demographic characteristics, MMSE score at diagnosis, and drug treatment profile.
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Affiliation(s)
- Josep Garre-Olmo
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain.,Deparment of Medical Sciences, University of Girona, Girona, Catalonia, Spain
| | - Sara Garcia-Ptacek
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Laia Calvó-Perxas
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain
| | - Oriol Turró-Garriga
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain
| | - Secundino López-Pousa
- Girona Biomedical Research Institute [IDIBGI] - Institut d'Assistència Sanitària, Girona, Catalonia, Spain
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer research, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Stockholm, Sweden.,Department of Geriatric Medicine, Karolinska University Hospital, Huddinge, Stockholm, Sweden
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12
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Lin CS, Lin SY, Chou MY, Chen LY, Wang KY, Chen LK, Lin YT, Loh CH. Hospitalization and associated factors in people with Alzheimer's disease residing in a long-term care facility in southern Taiwan. Geriatr Gerontol Int 2017; 17 Suppl 1:50-56. [PMID: 28436191 DOI: 10.1111/ggi.13033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 01/04/2023]
Abstract
AIM It has been reported that many people with dementia require hospitalizations. The objective of the present study was to determine predictive factors for hospitalizations in people with dementia. METHODS A total of 70 individuals with dementia living in a veterans' home in southern Taiwan were consecutively enrolled. During prospective follow up, all hospitalization events were recorded. RESULTS The mean age of residents with dementia was 86.1 ± 4.0 years, and the mean follow-up time for this population was 2.2 ± 1.1 years. Among individuals, 62.9% suffered from malnutrition or were at risk of malnutrition (minimal nutritional assessment-short form score ≤11), and 8.6% of individuals had a body mass index of <18.5 Kg/m2 . There were 52 (74.3%) individuals who had previously fallen. Overall, 51 of 70 residents were hospitalized during the follow-up period. In those individuals with previous falls, there was a significantly increased risk of hospitalization (odds ratio 5.61, 95% CI 1.18-26.7). Furthermore, three factors were significantly associated with the risk of fall, including handgrip strength, malnutrition and Mini-Mental State Examination score. CONCLUSIONS The results of the present study showed that hospitalization was a frequent event in residents with dementia living in a long-term care facility. The major predictor for hospital admission was history of a previous fall. Screening those with dementia for history of injurious falls and associated risk factors for falling could help identify those at risk of hospitalization, thus necessitating a comprehensive intervention to reduce hospitalization. Geriatr Gerontol Int 2017; 17 (Suppl. 1): 50-56.
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Affiliation(s)
- Chu-Sheng Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Aging and Health Research Center, National Yang Ming University
| | - Shih-Yi Lin
- Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Yueh Chou
- Aging and Health Research Center, National Yang Ming University.,Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Taichung, Taiwan
| | - Liang-Yu Chen
- Aging and Health Research Center, National Yang Ming University.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital
| | - Kuei-Yu Wang
- JiaLi Veterans Home, Veterans Affairs Council, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital
| | - Yu-Te Lin
- Aging and Health Research Center, National Yang Ming University.,Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital
| | - Ching-Hui Loh
- Department of Healthcare and Medical care, Veterans Affairs Council, Taiwan
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13
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de Souto Barreto P, Cadroy Y, Kelaiditi E, Vellas B, Rolland Y. The prognostic value of body-mass index on mortality in older adults with dementia living in nursing homes. Clin Nutr 2017; 36:423-428. [DOI: 10.1016/j.clnu.2015.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 11/09/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022]
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Abstract
Patients with different types of dementia may exhibit pathological eating habits, including food fads, hyperphagia, or even ingestion of inanimate objects. Several findings reveal that such eating alterations are more common in patients with frontotemporal dementia (FTD) than other types of dementia. Moreover, eating alterations may differ between the two variants of the disease, namely the behavioral variant and semantic dementia (SD). In this review, we summarized evidences regarding four areas: eating and body weight alterations in FTD, the most common assessment methods, anatomical correlates of eating disorders, and finally, proposed underlying mechanisms. An increasing understanding of the factors that contribute to eating abnormalities may allow first, a better comprehension of the clinical features of the disease and second, shed light on the mechanism underlying eating behaviors in the normal population.
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Affiliation(s)
| | - Vincenzo Silani
- b Department of Neurology and Laboratory of Neuroscience , IRCCS Istituto Auxologico Italiano, Dino Ferrari Centre , Milan , Italy.,c Department of Pathophysiology and Transplantation , Università degli Studi di Milano , Milan , Italy
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Koyama A, Hashimoto M, Tanaka H, Fujise N, Matsushita M, Miyagawa Y, Hatada Y, Fukuhara R, Hasegawa N, Todani S, Matsukuma K, Kawano M, Ikeda M. Malnutrition in Alzheimer's Disease, Dementia with Lewy Bodies, and Frontotemporal Lobar Degeneration: Comparison Using Serum Albumin, Total Protein, and Hemoglobin Level. PLoS One 2016; 11:e0157053. [PMID: 27336725 PMCID: PMC4919003 DOI: 10.1371/journal.pone.0157053] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/24/2016] [Indexed: 12/21/2022] Open
Abstract
Malnutrition among dementia patients is an important issue. However, the biochemical markers of malnutrition have not been well studied in this population. The purpose of this study was to compare biochemical blood markers among patients with Alzheimer's disease (AD), dementia with Lewy bodies (DLB), and frontotemporal lobar degeneration (FTLD). A total of 339 dementia outpatients and their family caregivers participated in this study. Low serum albumin was 7.2 times more prevalent among patients with DLB and 10.1 times more prevalent among those with FTLD than among those with AD, with adjustment for age. Low hemoglobin was 9.1 times more common in female DLB patients than in female AD patients, with adjustment for age. The levels of biochemical markers were not significantly correlated with cognitive function. Family caregivers of patients with low total protein, low albumin, or low hemoglobin were asked if the patients had loss of weight or appetite; 96.4% reported no loss of weight or appetite. In conclusion, nutritional status was worse in patients with DLB and FTLD than in those with AD. A multidimensional approach, including blood testing, is needed to assess malnutrition in patients with dementia.
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Affiliation(s)
- Asuka Koyama
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Mamoru Hashimoto
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hibiki Tanaka
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Noboru Fujise
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masateru Matsushita
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yusuke Miyagawa
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yutaka Hatada
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ryuji Fukuhara
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Noriko Hasegawa
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shuji Todani
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Kengo Matsukuma
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Michiyo Kawano
- Faculty of Human Life Science, Shokei University, Kumamoto, Japan
| | - Manabu Ikeda
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Religa D, Fereshtehnejad SM, Cermakova P, Edlund AK, Garcia-Ptacek S, Granqvist N, Hallbäck A, Kåwe K, Farahmand B, Kilander L, Mattsson UB, Nägga K, Nordström P, Wijk H, Wimo A, Winblad B, Eriksdotter M. SveDem, the Swedish Dementia Registry - a tool for improving the quality of diagnostics, treatment and care of dementia patients in clinical practice. PLoS One 2015; 10:e0116538. [PMID: 25695768 PMCID: PMC4335024 DOI: 10.1371/journal.pone.0116538] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/09/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Swedish Dementia Registry (SveDem) was developed with the aim to improve the quality of diagnostic work-up, treatment and care of patients with dementia disorders in Sweden. METHODS SveDem is an internet based quality registry where several indicators can be followed over time. It includes information about the diagnostic work-up, medical treatment and community support (www.svedem.se). The patients are diagnosed and followed-up yearly in specialist units, primary care centres or in nursing homes. RESULTS The database was initiated in May 2007 and covers almost all of Sweden. There were 28 722 patients registered with a mean age of 79.3 years during 2007-2012. Each participating unit obtains continuous online statistics from its own registrations and they can be compared with regional and national data. A report from SveDem is published yearly to inform medical and care professionals as well as political and administrative decision-makers about the current quality of diagnostics, treatment and care of patients with dementia disorders in Sweden. CONCLUSION SveDem provides knowledge about current dementia care in Sweden and serves as a framework for ensuring the quality of diagnostics, treatment and care across the country. It also reflects changes in quality dementia care over time. Data from SveDem can be used to further develop the national guidelines for dementia and to generate new research hypotheses.
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Affiliation(s)
- Dorota Religa
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
- Geriatric Clinic, Karolinska University Hospital, Stockholm, Sweden
- * E-mail:
| | - Seyed-Mohammad Fereshtehnejad
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Stockholm, Sweden
| | - Pavla Cermakova
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | | | - Sara Garcia-Ptacek
- Geriatric Clinic, Karolinska University Hospital, Stockholm, Sweden
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Stockholm, Sweden
| | | | | | | | - Bahman Farahmand
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | - Lena Kilander
- Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden
| | - Ulla-Britt Mattsson
- Neuropsychiatric clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Nägga
- Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Helle Wijk
- Sahlgrenska Academy, Institute of Health and Care Sciences at Gothenburg University, Gothenburg, Sweden
| | - Anders Wimo
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
- Centre for Research & Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Bengt Winblad
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division for Neurogeriatrics, Huddinge, Sweden
| | - Maria Eriksdotter
- Geriatric Clinic, Karolinska University Hospital, Stockholm, Sweden
- Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Division of Clinical Geriatrics, Stockholm, Sweden
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