Nutrition and Diet Considerations for Alzheimer’s Disease

Alzheimer’s is only one type of dementia, a neurocognitive disease that affects memory, language, and social behavior. The ability to reason and make sound choices regarding food can be challenging, even early on in the illness. In fact, weight loss has been documented in people with Alzheimer’s years before the diagnosis. Weight loss is associated with poorer health outcomes in dementia and old age.

Therefore it is important to understand ways of maintaining a healthy weight through nutrition, which includes intentional approaches to meals.

Alzheimer's prevalence

Alzheimer’s is the most common form of dementia, affecting about one in nine adults over age 65. The older we are the greater the chance of developing Alzheimer’s. In fact, more than 33% of those 85 and older live with it. It is important to review Alzheimer’s disease risk factors as they include specific diet recommendations for prevention. This article stands as an overview of good nutrition for those already diagnosed as well as diet considerations as the condition progresses.

Nutrition for older adults

Because Alzheimer’s affects mostly older adults, looking at basic nutritional needs for this age group makes sense. People in later life need the same macronutrients — carbohydrates, protein, and fat — as at any other time. However, caloric needs are less as metabolism declines around age 60. Meeting all nutritional requirements and maintaining a healthy weight with Alzheimer’s can be more challenging due to changes in cognitive function, mobility, and appetite.

Here are some general guidelines for eating well from the USDA's My Plate.

• Variety. Consuming a variety of foods is part of avoiding other chronic diseases such as high blood pressure, diabetes, and heart disease.
• Nutrients. Essential nutrients to prioritize are potassium, calcium, vitamin D, dietary fiber, and vitamin B12.
• Protein. Get enough protein throughout your day to maintain muscle mass. Try featuring seafood, dairy or fortified soy alternatives, or beans, peas, and lentils.
• Avoid some foods. Choose foods with little to no added sugar, saturated fats, and sodium. This includes beverages!
• Hydration. Dehydration is problematic for older adults. Drinking water often is key. Low- or fat-free milk, including lactose-free options, fortified soy beverages, and 100% juice are good options.
  
• Food groups. Specific guidelines about eating well from all five food groups plus a target for number of calories is available through MyPlate Plan.

Meal planning and preparation

Diet in terms of meal planning and preparation for those with Alzheimer's dementia means having a solid plan to secure all the daily food needed by the person. Driving, shopping, and cooking with Alzheimer’s dementia become challenging tasks as the ability to process detailed information fails. Also, an individual’s faltering sense of self-preservation may present as a lack of concern about food or an interest in sweets only. A decline in fine motor skills makes chopping and slicing foods unsafe. Therefore, those living with the condition will eventually need help with their diet.

Often family and friends are the first to notice these issues. Healthcare providers should be informed to help intervene and ensure the best nutrition. An example might be a referral to a registered dietician or medical social worker. Other helpful resources to know about include:

• Community food banks
• Meals-on-Wheels food delivery
• Council on Aging programs
• Frozen meals through Medicare Advantage
• Supplemental Nutrition Assistance Program (SNAP)

Food safety

When a person with Alzheimer’s has difficulty with regular cleaning practices or understanding food storage, acute health issues like food poisoning can arise. Loved ones are instrumental in improving these situations by sharing proper food-handling information with the person and then troubleshooting if possible. A referral to an occupational therapist can help reorient people with dementia to activities of daily living, including kitchen safety.

Appetite and socialization

Appetite typically declines in the later stages of Alzheimer’s. Eating with others is key as is adequate lighting and clean, comfortable surroundings. Being engaged improves intake; whether by conversation or helping with a meal or table prep. If noise keeps the person from focusing on food, consider making adjustments to the environment.

Community centers and churches often host shared meals. If transportation is an issue, ask your healthcare provider or a family member to help. In advanced Alzheimer’s, a regular caregiver or assisted living situation may be essential to guarantee food provision.

Also, making sure the affected person still has a choice and providing for that is helpful. If having the person over for a meal, include items they enjoy. If they seem to focus on only one or two foods, that is okay as long as it isn’t the norm.

Final tips to maximize intake:

• Variety helps! Display different colored foods against a contrasting plate or tablecloth.
• Texture. Experiment with texture to promote interest (e.g., slices of avocado versus guacamole).
• Time. Allow the person time and to eat with their hands even if messy.
• Extra calories. Fold in some extra calories in recipes (e.g., add heavy cream to mashed potatoes).

Supplements

Vitamin, mineral, and food supplements to prevent or slow Alzheimer’s and other dementias get a lot of media attention. The Alzheimer’s Association cites a systematic review of the use of vitamin C, vitamin D, vitamin E, omega-3 fatty acids, and ginkgo biloba that found little to no benefit in stopping the cognitive decline. Research continues to seek answers that include taking dietary supplements to benefit those with Alzheimer’s.

Individuals with Alzheimer’s may require the supplementation of vitamins and other nutrients. Vitamin B12 absorption wanes with age and a deficiency can result. Protein levels often need boosting. However, no supplement should replace the goal of a balanced diet which requires whole and varied foods. To decide if supplements are necessary — and to avoid medication interactions or unwanted side effects — it is essential to discuss all supplements with your healthcare provider.

Managing Alzheimer’s disease well is possible and includes understanding nutrition and diet interventions. Start with your primary care provider or dementia care specialist to discuss the best approaches to food and specific nutrient needs. This is so that healthy habits continue and problem-solving related to Alzheimer’s begins early. Stopping the progression of weight loss and nutrient deficiencies requires support and regular monitoring, all of which are available if you are empowered with information.