Diet to Maintain Health, Well-being of Alzheimer’s Patients: A Nutritionist’s View

When it comes to nutrition support for Alzheimer’s disease, we often focus on nutrient- and energy-specific recommendations to support cognitive brain function and the gut microbiome, as well as to reduce inflammation. 

A lesser-known consideration however, is the importance of assessing and prioritizing the ability, energy, and functionality of the patient in relation to the ability to eat food. All too often, malnutrition, secondary to changes in functionality, becomes a key factor in the deterioration of health status within this vulnerable population. 

Loss of appetite due to sensory changes and dysphagia (difficulty swallowing) are risk factors for malnutrition in Alzheimer’s. If caregivers don’t pay close attention, it is easy to overlook that the patient may not be receiving the nutrition they need, which can lead to further deficits and health decline. 

Cognitive impairment diseases such as Alzheimer’s and dementia reflect a higher degree of swallowing difficulty. According to a 2012 study, “most commonly, patients with dementia demonstrate a slowing of the swallowing process. Slowed swallow processes may increase time taken to finish a meal and subsequently increase the risk for poor nutritional status. Furthermore, patients with dementia often have difficulties self-feeding. These difficulties may relate to cognitive impairment, motor deficits such as weakness or apraxia, loss of appetite, and/or food avoidance.” 

The important role of attentive and intuitive caregivers cannot be stressed enough, and their ability to pick up on cues can be crucial. Below are some risk factors to consider when it comes to feeding people with Alzheimer’s disease:

• Forgetting to eat and drink 
• Difficulty communicating hunger and thirst 
• Inability to communicate desire for certain foods 
• Loss of appetite due to medications 
• Depression
• Dehydration 

Taking a proactive role in the nutrition status of patients with Alzheimer’s can make a big difference. Here are a few tips for caregivers to help improve the eating and drinking habits of a person with Alzheimer’s disease and ensure dietary needs are met: 

• Keep food diverse with a variety of colors and aromas. 
• Keep portions small and offer five to six small meals per day.
• Include herbs and spices, sauces, and broths for flavor.
• Serve food warm. 
• Offer soft foods such as scrambled eggs, smoothies, mashed potatoes, oatmeal, yogurt, baked fish, and chicken.
• Check the patient’s mouth after meals to ensure the food is eaten.
• When eating, make sure posture is appropriate, with the spine straight and the head leaning slightly forward. 
• Offer finger foods that don’t need utensils, such as sandwiches, mini egg muffins, fruits, and sushi. 

Depression is a major factor in the decline of nutritional status within this population. Depression can present in many forms, ranging from apathy to unpredictable anger. The role and attitude of caregivers is critical in creating the environment needed for the individual to feel inspired to participate in life and enjoy activities such as eating. 

Some of my favorite recommendations are: 

• Keeping the daily routine consistent. 
• Regularly scheduling visits with people and places the person enjoys. 
• Allowing the person to feel seen in their frustration or sadness by acknowledging and sharing your desire for them to feel better.
• Celebrating small successes and important milestones. 
• Gifting them with their favorite foods and sharing in their favorite activities with them.

Because Alzheimer’s disease can be a scary and often unpredictable experience for the individual, it is even more important for caregivers to stay attuned to any changes in the eating style and personality of the patient while offering care. As we continue to learn more about the disease and present new research and treatments, adequate nutritional status remains essential for quality of life and longevity. 

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Alana Kessler, MS, RD, CDN, E-RYT, is a registered dietitian, nutritionist, weight management expert, and an accredited member of the CDR (Commission on Dietetic Registration) and the American Dietetic Association. She is also a yoga and meditation teacher, Ayurveda specialist, and the founder of the New York City-based fully integrated mind, body, and spirit urban sanctuary, BE WELL. Alana’s BE WELL ARC System and Method Mapping technique is a holistic multidisciplinary approach to health and wellness that blends Eastern and clinical Western diet and lifestyle support to effect long-lasting behavior change.

A graduate of NYU with a BA and MS in clinical nutrition, Alana is dedicated to helping others learn how to nourish themselves, create balance, and understand their true nature through nutrition, yoga, and inner wellness. She leads Yin Yoga workshops and trainings as well as wellness retreats at international locations. Her health, fitness, and lifestyle expertise has been featured in Aaptiv.com, Droz.com, EatThis.com, RD.com, Redbook, WomensHealthmag.com, and Vogue. For more information, visit her website at bewellbyak.com.