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Cited by 442Nutrition and Health in AgingClinical Nutrition and GastroenterologyDementia and Cognitive Impairment Research

ESPEN guidelines on nutrition in dementia

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Volkert, Dorothee, Chourdakis, Michael, Faxen-Irving, Gerd, Frühwald, Thomas, Landi, Francesco, Suominen, Merja H., Vandewoude, Maurits, Wirth, Rainer +1 more·2015·Clinical Nutrition
DOI 10.1016/j.clnu.2015.09.004
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Abstract

Background Older people suffering from dementia are at increased risk of malnutrition due to various nutritional problems, and the question arises which interventions are effective in maintaining adequate nutritional intake and nutritional status in the course of the disease. It is of further interest whether supplementation of energy and/or specific nutrients is able to prevent further cognitive decline or even correct cognitive impairment, and in which situations artificial nutritional support is justified. Objective It is the purpose of these guidelines to cover these issues with evidence-based recommendations. Methods The guidelines were developed by an international multidisciplinary working group in accordance with officially accepted standards. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds and accepted in an online survey among ESPEN members. Results 26 recommendations for nutritional care of older persons with dementia are given. In every person with dementia, screening for malnutrition and close monitoring of body weight are recommended. In all stages of the disease, oral nutrition may be supported by provision of adequate, attractive food in a pleasant environment, by adequate nursing support and elimination of potential causes of malnutrition. Supplementation of single nutrients is not recommended unless there is a sign of deficiency. Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Artificial nutrition is suggested in patients with mild or moderate dementia for a limited period of time to overcome a crisis situation with markedly insufficient oral intake, if low nutritional intake is predominantly caused by a potentially reversible condition, but not in patients with severe dementia or in the terminal phase of life. Conclusion Nutritional care and support should be an integral part of dementia management. In all stages of the disease, the decision for or against nutritional interventions should be made on an individual basis after carefully balancing expected benefit and potential burden, taking the (assumed) patient will and general prognosis into account.

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  1. Preiser JC, Schneider SM. ESPEN disease-specific guideline framework. Clin Nutr 2011;30:549e52.
  2. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490.
  3. Weuve J, Hebert LE, Scherr PA, Evans DA. Deaths in the United States among persons with Alzheimer's disease (2010e2050). Alzheimers Dement 2014;10:e40e6.
  4. Feldman HH, Jacova C, Robillard A, Garcia A, Chow T, Borrie M, et al. Diagnosis and treatment of dementia: 2. Diagnosis. CMAJ 2008;178: 825e36.
  5. Patterson C, Feightner JW, Garcia A, Hsiung GY, MacKnight C, Sadovnick AD. Diagnosis and treatment of dementia: 1. Risk assessment and primary pre- vention of Alzheimer disease. CMAJ 2008;178:548e56.
  6. Bateman RJ, Xiong C, Benzinger TL, Fagan AM, Goate A, Fox NC, et al. Clinical and biomarker changes in dominantly inherited Alzheimer's disease. N Engl J Med 2012;367:795e804.
  7. Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc 2013;14:392e7.
  8. Vitaliano PP, Breen AR, Russo J, Albert M, Vitiello MV, Prinz PN. The clinical utility of the dementia rating scale for assessing Alzheimer patients. J Chronic Dis 1984;37:743e53.
  9. Moelter ST, Glenn MA, Xie SX, Chittams J, Clark CM, Watson M, et al. The dementia severity rating scale predicts clinical dementia rating sum of boxes scores. Alzheimer Dis Assoc Disord 2015;29:158e60.
  10. Reisberg B, Ferris SH, de Leon MJ, Crook T. The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry 1982;139: 1136e9.
  11. Belmin J. Practical guidelines for the diagnosis and management of weight loss in Alzheimer's disease: a consensus from appropriateness ratings of a large expert panel. J Nutr Health Aging 2007;11:33e7.
  12. Gillette-Guyonnet S, Nourhashemi F, Andrieu S, de Glisezinski I, Ousset PJ, Riviere D, et al. Weight loss in Alzheimer disease. Am J Clin Nutr 2000;71: 637Se42S.
  13. Gillette Guyonnet S, Abellan Van Kan G, Alix E, Andrieu S, Belmin J, Berrut G, et al. IANA (International Academy on Nutrition and Aging) Expert Group: weight loss and Alzheimer's disease. J Nutr Health Aging 2007;11:38e48.
  14. White H, Pieper C, Schmader K, Fillenbaum G. Weight change in Alzheimer's disease. J Am Geriatr Soc 1996;44:265e72.
  15. Albanese E, Taylor C, Siervo M, Stewart R, Prince MJ, Acosta D. Dementia severity and weight loss: a comparison across eight cohorts. The 10/66 study. Alzheimers Dement 2013;9:649e56.
  16. Smith KL, Greenwood CE. Weight loss and nutritional considerations in Alzheimer disease. J Nutr Elder 2008;27:381e403.
  17. Grundman M, Corey-Bloom J, Jernigan T, Archibald S, Thal LJ. Low body weight in Alzheimer's disease is associated with mesial temporal cortex atrophy. Neurology 1996;46:1585e91.
  18. Vanhanen M, Kivipelto M, Koivisto K, Kuusisto J, Mykkanen L, Helkala EL, et al. APOE-4 is associated with weight loss in women with AD: a popula- tion-based study. Neurology 2001;56:655e9.
  19. Fillit H, Ding WH, Buee L, Kalman J, Altstiel L, Lawlor B, et al. Elevated circulating tumor necrosis factor levels in Alzheimer's disease. Neurosci Lett 1991;129:318e20.
  20. Zuliani G, Ranzini M, Guerra G, Rossi L, Munari MR, Zurlo A, et al. Plasma cytokines profile in older subjects with late onset Alzheimer's disease or vascular dementia. J Psychiatr Res 2007;41:686e93.
  21. Stanciu I, Larsson M, Nordin S, Adolfsson R, Nilsson LG, Olofsson JK. Olfactory impairment and subjective olfactory complaints independently predict conversion to dementia: a longitudinal, population-based study. J Int Neu- ropsychol Soc 2014;20:209e17.
  22. Olofsson JK, Nordin S, Wiens S, Hedner M, Nilsson LG, Larsson M. Odor identification impairment in carriers of ApoE-varepsilon4 is independent of clinical dementia. Neurobiol Aging 2010;31:567e77.
  23. Lechowski L, de Stampa M, Denis B, Tortrat D, Chassagne P, Robert P, et al. Patterns of loss of abilities in instrumental activities of daily living in Alz- heimer's disease: the REAL cohort study. Dement Geriatr Cogn Disord 2008;25:46e53.
  24. Silva P, Kergoat MJ, Shatenstein B. Challenges in managing the diet of older adults with early-stage Alzheimer dementia: a caregiver perspective. J Nutr Health Aging 2013;17:142e7.
  25. Chang CC, Roberts BL. Feeding difficulty in older adults with dementia. J Clin Nurs 2008;17:2266e74.
  26. Keller HH, Edward HG, Cook C. Mealtime experiences of families with de- mentia. Am J Alzheimers Dis Other Demen 2006;21:431e8.
  27. Aselage MB, Amella EJ. An evolutionary analysis of mealtime difficulties in older adults with dementia. J Clin Nurs 2010;19:33e41.
  28. Watson R, Deary IJ. Measuring feeding difficulty in patients with dementia: multivariate analysis of feeding problems, nursing intervention and in- dicators of feeding difficulty. J Adv Nurs 1994;20:283e7.
  29. Alagiakrishnan K, Bhanji RA, Kurian M. Evaluation and management of oropharyngeal dysphagia in different types of dementia: a systematic re- view. Arch Gerontol Geriatr 2013;56:1e9.
  30. Chouinard J, Lavigne E, Villeneuve C. Weight loss, dysphhagia, and outcome in advanced dementia. Dysphagia 1998;13:151e5.
  31. Langmore SE, Skarupski KA, Park PS, Fries BE. Predictors of aspiration pneumonia in nursing home residents. Dysphagia 2002;17:298e307.
  32. Miller SL, Wolfe RR. The danger of weight loss in the elderly. J Nutr Health Aging 2008;12:487e91.
  33. Chapman IM. Weight loss in older persons. Med Clin North Am 2011;95: 579e93. xi.
  34. Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: a narrative review. Maturitas 2013;76:296e302.
  35. McMinn J, Steel C, Bowman A. Investigation and management of uninten- tional weight loss in older adults. BMJ 2011;342:d1732.
  36. White H, Pieper C, Schmader K. The association of weight change in Alz- heimer's disease with severity of disease and mortality: a longitudinal analysis. J Am Geriatr Soc 1998;46:1223e7.
  37. Guerin O, Andrieu S, Schneider SM, Cortes F, Cantet C, Gillette-Guyonnet S, et al. Characteristics of Alzheimer's disease patients with a rapid weight loss during a six-year follow-up. Clin Nutr 2009;28:141e6.
  38. Hanson LC, Ersek M, Lin FC, Carey TS. Outcomes of feeding problems in advanced dementia in a nursing home population. J Am Geriatr Soc 2013;61: 1692e7.
  39. Faxen-Irving G, Basun H, Cederholm T. Nutritional and cognitive relation- ships and long-term mortality in patients with various dementia disorders. Age Ageing 2005;34:136e41.
  40. Gambassi G, Landi F, Lapane KL, Sgadari A, Mor V, Bernabei R. Predictors of mortality in patients with Alzheimer's disease living in nursing homes. J Neurol Neurosurg Psychiatry 1999;67:59e65.
  41. Mitchell SL, Teno JM, Kiely DK, Shaffer ML, Jones RN, Prigerson HG, et al. The clinical course of advanced dementia. N Engl J Med 2009;361:1529e38.
  42. Morley JE. Nutrition and the brain. Clin Geriatr Med 2010;26:89e98.
  43. Lourida I, Soni M, Thompson-Coon J, Purandare N, Lang IA, Ukoumunne OC, et al. Mediterranean diet, cognitive function, and dementia: a systematic review. Epidemiology 2013;24:479e89.
  44. Lopes da Silva S, Vellas B, Elemans S, Luchsinger J, Kamphuis P, Yaffe K, et al. Plasma nutrient status of patients with Alzheimer's disease: systematic re- view and meta-analysis. Alzheimers Dement 2014;10:485e502.
  45. Kamphuis PJ, Scheltens P. Can nutrients prevent or delay onset of Alz- heimer's disease? J Alzheimers Dis 2010;20:765e75.
  46. Orsitto G, Fulvio F, Tria D, Turi V, Venezia A, Manca C. Nutritional status in hospitalized elderly patients with mild cognitive impairment. Clin Nutr 2009;28:100e2.
  47. Coin A, Veronese N, De Rui M, Mosele M, Bolzetta F, Girardi A, et al. Nutri- tional predictors of cognitive impairment severity in demented elderly pa- tients: the key role of BMI. J Nutr Health Aging 2012;16:553e6.
  48. Wirth R, Voss C, Smoliner C, Sieber CC, Bauer JM, Volkert D. Complications and mortality after percutaneous endoscopic gastrostomy in geriatrics: a prospective multicenter observational trial. J Am Med Dir Assoc 2012;13: 228e33.
  49. White HK, McConnell ES, Bales CW, Kuchibhatla M. A 6-month observational study of the relationship between weight loss and behavioral symptoms in institutionalized Alzheimer's disease subjects. J Am Med Dir Assoc 2004;5: 89e97.
  50. Soto ME, Secher M, Gillette-Guyonnet S, Abellan van Kan G, Andrieu S, Nourhashemi F, et al. Weight loss and rapid cognitive decline in community- dwelling patients with Alzheimer's disease. J Alzheimers Dis 2012;28: 647e54.
  51. Guerin O, Andrieu S, Schneider SM, Milano M, Boulahssass R, Brocker P, et al. Different modes of weight loss in Alzheimer disease: a prospective study of 395 patients. Am J Clin Nutr 2005;82:435e41.
  52. Ousset PJ, Nourhashemi F, Reynish E, Vellas B. Nutritional status is associated with disease progression in very mild Alzheimer disease. Alzheimer Dis Assoc Disord 2008;22:66e71.
  53. Raivio M, Eloniemi-Sulkava U, Laakkonen ML, Saarenheimo M, Pietila M, Tilvis R, et al. How do officially organized services meet the needs of elderly caregivers and their spouses with Alzheimer's disease? Am J Alzheimers Dis Other Demen 2007;22:360e8.
  54. Grafstr€ om M, Fratiglioni L, Sandman PO, Winblad B. Health and social con- sequences for relatives of demented and non-demented elderly. A popula- tion-based study. J Clin Epidemiol 1992;45:861e70.
  55. Wimo A, von Strauss E, Nordberg G, Sassi F, Johansson L. Time spent on informal and formal care giving for persons with dementia in Sweden. Health Policy 2002;61:255e68.
  56. Keller HH, Smith D, Kasdorf C, Dupuis S, Schindel Martin L, Edward G, et al. Nutrition education needs and resources for dementia care in the commu- nity. Am J Alzheimers Dis Other Demen 2008;23:13e22.
  57. Amella EJ. Feeding and hydration issues for older adults with dementia. Nurs Clin North Am 2004;39:607e23.
  58. Amella EJ, Grant AP, Mulloy C. Eating behavior in persons with moderate to late-stage dementia: assessment and interventions. J Am Psychiatr Nurses Assoc 2008;13:360e7.
  59. Fjellstrom C, Starkenberg A, Wesslen A, Licentiate MS, Tysen Backstrom AC, Faxen-Irving G, et al. To be a good food provider: an exploratory study among spouses of persons with Alzheimer's disease. Am J Alzheimers Dis Other Demen 2010;25:521e6.
  60. Hughes G, Bennett KM, Hetherington MM. Old and alone: barriers to healthy eating in older men living on their own. Appetite 2004;43:269e76.
  61. Puranen TM, Pietila SE, Pitkala KH, Kautiainen H, Raivio M, Eloniemi- Sulkava U, et al. Caregivers' male gender is associated with poor nutrient Intake in AD families (NuAD-Trial). J Nutr Health Aging 2014;18:672e6.
  62. Pasman HR, The BA, Onwuteaka-Philipsen BD, van der Wal G, Ribbe MW. Feeding nursing home patients with severe dementia: a qualitative study. J Adv Nurs 2003;42:304e11.
  63. Riviere S, Gillette-Guyonnet S, Andrieu S, Nourhashemi F, Lauque S, Cantet C, et al. Cognitive function and caregiver burden: predictive factors for eating behaviour disorders in Alzheimer's disease. Int J Geriatr Psychiatry 2002;17: 950e5.
  64. Bilotta C, Bergamaschini L, Arienti R, Spreafico S, Vergani C. Caregiver burden as a short-term predictor of weight loss in older outpatients suffering from mild to moderate Alzheimer's disease: a three months follow-up study. Aging Ment Health 2010;14:481e8.
  65. Johansson L, Sidenvall B, Malmberg B, Christensson L. Who will become malnourished? A prospective study of factors associated with malnutrition in older persons living at home. J Nutr Health Aging 2009;13:855e61.
  66. Torres SJ, McCabe M, Nowson CA. Depression, nutritional risk and eating behaviour in older caregivers. J Nutr Health Aging 2010;14:442e8.
  67. Rullier L, Lagarde A, Bouisson J, Bergua V, Torres M, Barberger-Gateau P. Psychosocial correlates of nutritional status of family caregivers of persons with dementia. Int Psychogeriatr 2014;26:105e13.
  68. Rullier L, Lagarde A, Bouisson J, Bergua V, Barberger-Gateau P. Nutritional status of community-dwelling older people with dementia: associations with individual and family caregivers' characteristics. Int J Geriatr Psychiatry 2013;28:580e8.
  69. Arvanitakis M, Beck A, Coppens P, De Man F, Elia M, Hebuterne X, et al. Nutrition in care homes and home care: how to implement adequate stra- tegies (report of the Brussels Forum (22e23 November 2007)). Clin Nutr 2008;27:481e8.
  70. Suominen MH, Sandelin E, Soini H, Pitkala KH. How well do nurses recognize malnutrition in elderly patients? Eur J Clin Nutr 2009;63:292e6.
  71. Volkert D, Saeglitz C, Gueldenzoph H, Sieber CC, Stehle P. Undiagnosed malnutrition and nutrition-related problems in geriatric patients. J Nutr Health Aging 2010;14:387e92.
  72. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22:415e21.
  73. Phillips MB, Foley AL, Barnard R, Isenring EA, Miller MD. Nutritional screening in community-dwelling older adults: a systematic literature re- view. Asia Pac J Clin Nutr 2010;19:440e9.
  74. van Bokhorst-de van der Schueren MAE, Guaitoli PR, Jansma EP, de Vet HCW. Nutrition screening tools: does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr 33:39e58.
  75. Vandewoude M, Van Gossum A. Nutritional screening strategy in nonage- narians: the value of the MNA-SF (mini nutritional assessment short form) in NutriAction. J Nutr Health Aging 2013;17:310e4.
  76. Kaiser R, Winning K, Uter W, Lesser S, Stehle P, Sieber CC, et al. Comparison of two different approaches for the application of the mini nutritional assessment in nursing homes: resident interviews versus assessment by nursing staff. J Nutr Health Aging 2009;13:863e9.
  77. Tully MW, Lambros Matrakas K, Musallam K. The eating behavior scale: a simple method of assessing functional ability in patients with Alzheimer's disease. J Nutr Health Aging 1998;2:119e21.
  78. Stroebele N, De Castro JM. Effect of ambience on food intake and food choice. Nutrition 2004;20:821e38.
  79. Nieuwenhuizen WF, Weenen H, Rigby P, Hetherington MM. Older adults and patients in need of nutritional support: review of current treatment options and factors influencing nutritional intake. Clin Nutr 2010;29:160e9.
  80. de Castro JM, Brewer EM. The amount eaten in meals by humans is a power function of the number of people present. Physiol Behav 1992;51:121e5.
  81. Nijs KA, de Graaf C, Siebelink E, Blauw YH, Vanneste V, Kok FJ, et al. Effect of family-style meals on energy intake and risk of malnutrition in dutch nursing home residents: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2006;61:935e42.
  82. Nijs KA, de Graaf C, Kok FJ, van Staveren WA. Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: cluster randomised controlled trial. BMJ 2006;332:1180e4.
  83. Liu W, Cheon J, Thomas SA. Interventions on mealtime difficulties in older adults with dementia: a systematic review. Int J Nurs Stud 2013.
  84. Whear R, Abbott R, Thompson-Coon J, Bethel A, Rogers M, Hemsley A, et al. Effectiveness of mealtime interventions on behavior symptoms of people with dementia living in care homes: a systematic review. J Am Med Dir Assoc 2014;15:185e93.
  85. Santo P MJ, Boczko F. The Breakfast Club: results of a study examining the effectiveness of a multi-modality group communication treatment. Am J Alzheimer's Dis 1998;13:146e58.
  86. Charras K, Fremontier M. Sharing meals with institutionalized people with dementia: a natural experiment. J Gerontol Soc Work 2010;53:436e48.
  87. Edwards NE, Beck AM. The influence of aquariums on weight in individuals with dementia. Alzheimer Dis Assoc Disord 2013;27:379e83.
  88. Dunne TE, Neargarder SA, Cipolloni PB, Cronin-Golomb A. Visual contrast enhances food and liquid intake in advanced Alzheimer's disease. Clin Nutr 2004;23:533e8.
  89. Young KWH, Greenwood CE. Shift in diurnal feeding patterns in nursing home residents with Alzheimer's disease. J Gerontol A Biol Sci Med Sci 2001;56:M700e6.
  90. Young KW, Binns MA, Greenwood CE. Meal delivery practices do not meet needs of Alzheimer patients with increased cognitive and behavioral diffi- culties in a long-term care facility. J Gerontol A Biol Sci Med Sci 2001;56: M656e61.
  91. Odlund Olin A, Armyr I, Soop M, Jerstrom S, Classon I, Cederholm T, et al. Energy-dense meals improve energy intake in elderly residents in a nursing home. Clin Nutr 2003;22:125e31.
  92. Smoliner C, Norman K, Scheufele R, Hartig W, Pirlich M, Lochs H. Effects of food fortification on nutritional and functional status in frail elderly nursing home residents at risk of malnutrition. Nutrition 2008;24:1139e44.
  93. Biernacki C, Barratt J. Improving the nutritional status of people with de- mentia. Br J Nurs 2001;10:1104e14.
  94. Soltesz KS, Dayton JH. Finger foods help those with Alzheimer's maintain weight. J Am Diet Assoc 1993;93:1106e8.
  95. Soltesz KS, Dayton JH. The effects of menu modification to increase dietary intake and maintain the weight of Alzheimer residents. Am J Alzheimers Dis Other Demen 1995;10:20e3.
  96. Boylston E, Ryan C, Brown C, Westfall B. Preventing precipitous weight loss in demented patients by altering food texture. J Nutr Elder 1996;15:43e8.
  97. Niedert KC. Position of the American Dietetic Association: liberalization of the diet prescription improves quality of life for older adults in long-term care. J Am Diet Assoc 2005;105:1955e65.
  98. Keller HH, Gibbs AJ, Boudreau LD, Goy RE, Pattillo MS, Brown HM. Prevention of weight loss in dementia with comprehensive nutritional treatment. J Am Geriatr Soc 2003;51:945e52.
  99. Lin LC, Watson R, Wu SC. What is associated with low food intake in older people with dementia? J Clin Nurs 2010;19:53e9.
  100. Wong A, Burford S, Wyles CL, Mundy H, Sainsbury R. Evaluation of strategies to improve nutrition in people with dementia in an assessment unit. J Nutr Health Aging 2008;12:309e12.
  101. Kayser-Jones J. Mealtime in nursing homes: the importance of individualized care. J Geront Nurs 1996;22:26e31.
  102. Kayser-Jones J, Schell E. The mealtime experience of a cognitively impaired elder: ineffective and effective strategies. J Gerontol Nurs 1997;23:33e9.
  103. Boffelli S, Rozzini R, Trabucchi M. Nutritional intervention in special care units for dementia. J Am Geriatr Soc 2004;52:1216e7.
  104. Manning AM, Means JG. A self-feeding program for geriatric patients in a skilled nursing facility. J Am Geriatr Soc 1975;75:275e6.
  105. Lange-Alberts ME, Shott S. Nutritional intake. Use of touch and verbal cuing. J Gerontol Nurs 1994;20:36e40.
  106. Van Ort S, Phillips LR. Nursing intervention to promote functional feeding. J Gerontol Nurs 1995;21:6e14.
  107. Simmons SF, Osterweil D, Schnelle JF. Improving food intake in nursing home residents with feeding assistance: a staffing analysis. J Gerontol A Biol Sci Med Sci 2001;56:M790e4.
  108. Simmons SF, Schnelle JF. Individualized feeding assistance care for nursing home residents: staffing requirements to implement two interventions. J Gerontol A Biol Sci Med Sci 2004;59:M966e73.
  109. Simmons SF, Keeler E, Zhuo X, Hickey KA, Sato HW, Schnelle JF. Prevention of unintentional weight loss in nursing home residents: a controlled trial of feeding assistance. J Am Geriatr Soc 2008;56:1466e73.
  110. Altus DE, Engelman KK, Mathews RM. Using family-style meals to increase participation and communication in persons with dementia. J Gerontol Nurs 2002;28:47e53.
  111. Amella EJ. Factors influencing the proportion of food consumed by nursing home residents with dementia. J Am Geriatr Soc 1999;47:879e85.
  112. Athlin E, N A. Interaction between patients with severe dementia and their caregivers during feeding in a task-assignment versus a patient-assignment care system. Eur Nurse 1998;3:215e27.
  113. Beattie ER, Algase DL, Song J. Keeping wandering nursing home residents at the table: improving food intake using a behavioral communication inter- vention. Aging Ment Health 2004;8:109e16.
  114. Coyne ML, Hoskins L. Improving eating behaviors in dementia using behavioral strategies. Clin Nurs Res 1997;6:275e90.
  115. Thomas DR. Guidelines for the use of orexigenic drugs in long-term care. Nutr Clin Pract 2006;21:82e7.
  116. Volicer L, Stelly M, Morris J, McLaughlin J, Volicer BJ. Effects of dronabinol on anorexia and disturbed behavior in patients with Alzheimer's disease. Int J Geriatr Psychiatry 1997;12:913e9.
  117. Woodward MR, Harper DG, Stolyar A, Forester BP, Ellison JM. Dronabinol for the treatment of agitation and aggressive behavior in acutely hospitalized severely demented patients with noncognitive behavioral symptoms. Am J Geriatr Psychiatry 2014;22:415e9.
  118. Yeh SS, Wu SY, Lee TP, Olson JS, Stevens MR, Dixon T, et al. Improvement in quality-of-life measures and stimulation of weight gain after treatment with megestrol acetate oral suspension in geriatric cachexia: results of a double- blind, placebo-controlled study. J Am Geriatr Soc 2000;48:485e92.
  119. Simmons SF, Walker KA, Osterweil D. The effect of megestrol acetate on oral food and fluid intake in nursing home residents: a pilot study. J Am Med Dir Assoc 2005;6:S5e11.
  120. Domecq JP, Prutsky G, Leppin A, Sonbol MB, Altayar O, Undavalli C, et al. Clinical review: drugs commonly associated with weight change: a sys- tematic review and meta-analysis. J Clin Endocrinol Metab 2015;100: 363e70.
  121. Riviere S, Gillette-Guyonnet S, Voisin T, Reynish E, Andrieu S, Lauque S, et al. A nutritional education program could prevent weight loss and slow cognitive decline in Alzheimer's disease. J Nutr Health Aging 2001;5:295e9.
  122. Salva A, Andrieu S, Fernandez E, Schiffrin EJ, Moulin J, Decarli B, et al. Health and nutrition promotion program for patients with dementia (NutriAlz): cluster randomized trial. J Nutr Health Aging 2011;15:822e30.
  123. Suominen MH, Kivisto SM, Pitkala KH. The effects of nutrition education on professionals' practice and on the nutrition of aged residents in dementia wards. Eur J Clin Nutr 2007;61:1226e32.
  124. Mamhidir AG, Karlsson I, Norberg A, Mona K. Weight increase in patients with dementia, and alteration in meal routines and meal environment after integrity promoting care. J Clin Nurs 2007;16:987e96.
  125. Chang CC, Lin LC. Effects of a feeding skills training programme on nursing assistants and dementia patients. J Clin Nurs 2005;14:1185e92.
  126. Lin LC, Huang YJ, Su SG, Watson R, Tsai BW, Wu SC. Using spaced retrieval and Montessori-based activities in improving eating ability for residents with dementia. Int J Geriatr Psychiatry 2010;25:953e9.
  127. Lin LC, Huang YJ, Watson R, Wu SC, Lee YC. Using a Montessori method to increase eating ability for institutionalised residents with dementia: a crossover design. J Clin Nurs 2011;20:3092e101.
  128. Alibhai SM, Greenwood C, Payette H. An approach to the management of unintentional weight loss in elderly people. CMAJ 2005;172:773e80.
  129. Cederholm T, Palmblad J. Are omega-3 fatty acids options for prevention and treatment of cognitive decline and dementia? Curr Opin Clin Nutr Metab Care 2010;13:150e5.
  130. Cederholm T, Salem Jr N, Palmblad J. omega-3 fatty acids in the prevention of cognitive decline in humans. Adv Nutr 2013;4:672e6.
  131. Oulhaj A, Refsum H, Beaumont H, Williams J, King E, Jacoby R, et al. Ho- mocysteine as a predictor of cognitive decline in Alzheimer's disease. Int J Geriatr Psychiatry 2010;25:82e90.
  132. Aisen PS, Schneider LS, Sano M, Diaz-Arrastia R, van Dyck CH, Weiner MF, et al. High-dose B vitamin supplementation and cognitive decline in Alz- heimer disease: a randomized controlled trial. JAMA 2008;300:1774e83.
  133. Sun Y, Lu CJ, Chien KL, Chen ST, Chen RC. Efficacy of multivitamin supple- mentation containing vitamins B6 and B12 and folic acid as adjunctive treatment with a cholinesterase inhibitor in Alzheimer's disease: a 26-week, randomized, double-blind, placebo-controlled study in Taiwanese patients. Clin Ther 2007;29:2204e14.
  134. Vogel T, Dali-Youcef N, Kaltenbach G, Andres E. Homocysteine, vitamin B12, folate and cognitive functions: a systematic and critical review of the liter- ature. Int J Clin Pract 2009;63:1061e7.
  135. Loef M, Schrauzer GN, Walach H. Selenium and Alzheimer's disease: a sys- tematic review. J Alzheimers Dis 2011;26:81e104.
  136. Kessler H, Bayer TA, Bach D, Schneider-Axmann T, Supprian T, Herrmann W, et al. Intake of copper has no effect on cognition in patients with mild Alz- heimer's disease: a pilot phase 2 clinical trial. J Neural Transm 2008;115: 1181e7.
  137. Schlogl M, Holick MF. Vitamin D and neurocognitive function. Clin Interv Aging 2014;9:559e68.
  138. Annweiler C, Dursun E, Feron F, Gezen-Ak D, Kalueff AV, Littlejohns T, et al. 'Vitamin D and cognition in older adults': updated international recom- mendations. J Intern Med 2015;277:45e57.
  139. Lochs H, Allison SP, Meier R, Pirlich M, Kondrup J, Schneider S, et al. Intro- ductory to the ESPEN guidelines on enteral nutrition: terminology, defini- tions and general topics. Clin Nutr 2006;25:180e6.
  140. Carver AD, Dobson AM. Effects of dietary supplementation of elderly demented hospital residents. J Hum Nutr Diet 1995;8:389e94.
  141. de Sousa OL, Amaral TF. Three-week nutritional supplementation effect on long-term nutritional status of patients with mild Alzheimer disease. Alz- heimer Dis Assoc Disord 2012;26:119e23.
  142. Gil Gregorio P, Ramirez Diaz SP, Ribera Casado JM. Dementia and Nutrition. Intervention study in institutionalized patients with Alzheimer disease. J Nutr Health Aging 2003;7:304e8.
  143. Lauque S, Arnaud-Battandier F, Gillette S, Plaze JM, Andrieu S, Cantet C, et al. Improvement of weight and fat-free mass with oral nutritional supple- mentation in patients with Alzheimer's disease at risk of malnutrition: a prospective randomized study. J Am Geriatr Soc 2004;52:1702e7.
  144. Navrátilová M, Jarkovsky J, Ceßková E, Leonard B, Sobotka L. Alzheimer disease: malnutrition and nutritional support. Clin Exp Pharmacol Physiol 2007;34:11e3.
  145. Parrott MD, Young KW, Greenwood CE. Energy-containing nutritional sup- plements can affect usual energy intake postsupplementation in institu- tionalized seniors with probable Alzheimer's disease. J Am Geriatr Soc 2006;54:1382e7.
  146. Pivi GA, da Silva RV, Juliano Y, Novo NF, Okamoto IH, Brant CQ, et al. A prospective study of nutrition education and oral nutritional supplementa- tion in patients with Alzheimer's disease. Nutr J 2011;10:98.
  147. Wouters-Wesseling W, Slump E, Kleijer CN, de Groot LC, van Staveren WA. Early nutritional supplementation immediately after diagnosis of infectious disease improves body weight in psychogeriatric nursing home residents. Aging Clin Exp Res 2006;18:70e4.
  148. Wouters-Wesseling W, Rozendaal M, Snijder M, Graus Y, Rimmelzwaan G, de Groot L, et al. Effect of a complete nutritional supplement on antibody response to influenza vaccine in elderly people. J Gerontol A Biol Sci Med Sci 2002;57:563e6.
  149. Young KW, Greenwood CE, van Reekum R, Binns MA. Providing nutrition supplements to institutionalized seniors with probable Alzheimer's disease is least beneficial to those with low body weight status. J Am Geriatr Soc 2004;52:1305e12.
  150. Faxen-Irving G, Andren-Olsson B, af Geijerstam A, Basun H, Cederholm T. The effect of nutritional intervention in elderly subjects residing in group-living for the demented. Eur J Clin Nutr 2002;56:221e7.
  151. Allen VJ, Methven L, Gosney MA. Use of nutritional complete supplements in older adults with dementia: systematic review and meta-analysis of clinical outcomes. Clin Nutr 2013;32:950e7.
  152. 177Alzheimer's Disease International (ADI). Nutrition and dementia. A review of available research, 2014 (accessed 14.10.15 at: http://www.alz.co.uk/sites/ default/files/pdfs/nutrition-and-dementia.pdf).
  153. Hanson LC, Ersek M, Gilliam R, Carey TS. Oral feeding options for people with dementia: a systematic review. J Am Geriatr Soc 2011;59:463e72.
  154. Hines S, Wilson J, McCrow J, Abbey J, Sacre S. Oral liquid nutritional sup- plements for people with dementia in residential aged care facilities. Int J Evid Based Healthc 2010;8:248e51.
  155. van Wijk N, Broersen LM, de Wilde MC, Hageman RJ, Groenendijk M, Sijben JW, et al. Targeting synaptic dysfunction in Alzheimer's disease by administering a specific nutrient combination. J Alzheimers Dis 2014;38: 459e79.
  156. Scheltens P, Twisk JW, Blesa R, Scarpini E, von Arnim CA, Bongers A, et al. Efficacy of Souvenaid in mild Alzheimer's disease: results from a random- ized, controlled trial. J Alzheimers Dis 2012;31:225e36.
  157. Kamphuis PJ, Verhey FR, Olde Rikkert MG, Twisk JW, Swinkels SH, Scheltens P. Effect of a medical food on body mass index and activities of daily living in patients with Alzheimer's disease: secondary analyses from a randomized, controlled trial. J Nutr Health Aging 2011;15:672e6.
  158. Mi W, van Wijk N, Cansev M, Sijben JW, Kamphuis PJ. Nutritional approaches in the risk reduction and management of Alzheimer's disease. Nutrition 2013;29:1080e9.
  159. Planas M, Conde M, Audivert S, Perez-Portabella C, Burgos R, Chacon P, et al. Micronutrient supplementation in mild Alzheimer disease patients. Clin Nutr 2004;23:265e72.
  160. Salas-Salvado J, Torres M, Planas M, Altimir S, Pagan C, Gonzalez ME, et al. Effect of oral administration of a whole formula diet on nutritional and cognitive status in patients with Alzheimer's disease. Clin Nutr 2005;24: 390e7.
  161. Chan A, Paskavitz J, Remington R, Rasmussen S, Shea TB. Efficacy of a vitamin/nutriceutical formulation for early-stage Alzheimer's disease: a 1- year, open-label pilot study with an 16-month caregiver extension. Am J Alzheimers Dis Other Demen 2008;23:571e85.
  162. Remington R, Chan A, Paskavitz J, Shea TB. Efficacy of a vitamin/nutriceutical formulation for moderate-stage to later-stage Alzheimer's disease: a pla- cebo-controlled pilot study. Am J Alzheimers Dis Other Demen 2009;24: 27e33.
  163. Remington R, Bechtel C, Larsen D, Samar A, Doshanjh L, Fishman P, et al. A phase II randomized clinical trial of a nutritional formulation for cognition and mood in Alzheimer's disease. J Alzheimers Dis 2015;45:395e405.
  164. Henderson ST. Ketone bodies as a therapeutic for Alzheimer's disease. Neurotherapeutics 2008;5:470e80.
  165. Henderson ST, Vogel JL, Barr LJ, Garvin F, Jones JJ, Costantini LC. Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer's disease: a ran- domized, double-blind, placebo-controlled, multicenter trial. Nutr Metab (Lond) 2009;6:31.
  166. Henderson ST, Poirier J. Pharmacogenetic analysis of the effects of poly- morphisms in APOE, IDE and IL1B on a ketone body based therapeutic on cognition in mild to moderate Alzheimer's disease; a randomized, double- blind, placebo-controlled study. BMC Med Genet 2011;12:137.
  167. Mecocci P, Tinarelli C, Schulz RJ, Polidori MC. Nutraceuticals in cognitive impairment and Alzheimer's disease. Front Pharmacol 2014;5:147.
  168. Brondino N, Re S, Boldrini A, Cuccomarino A, Lanati N, Barale F, et al. Cur- cumin as a therapeutic agent in dementia: a mini systematic review of hu- man studies. ScientificWorldJournal 2014;2014:174282.
  169. More MI, Freitas U, Rutenberg D. Positive effects of soy lecithin-derived phosphatidylserine plus phosphatidic acid on memory, cognition, daily functioning, and mood in elderly patients with Alzheimer's disease and dementia. Adv Ther 2014;31:1247e62.
  170. Kato-Kataoka A, Sakai M, Ebina R, Nonaka C, Asano T, Miyamori T. Soybean- derived phosphatidylserine improves memory function of the elderly Japa- nese subjects with memory complaints. J Clin Biochem Nutr 2010;47: 246e55.
  171. Marckmann G, Sandberger G, Wiesing U. Limiting life-prolonging treat- ments: a practical guidance reflecting the current legislation in Germany. Dtsch Med Wochenschr 2010;135:570e4.
  172. Beauchamp TL, Childress JF. Principles of biomedical ethics. 5th ed. New York: Oxford University Press, Inc.; 2001.
  173. Ganzini L. Artificial nutrition and hydration at the end of life: ethics and evidence. Palliat Support Care 2006;4:135e43.
  174. Murphy LM, Lipman TO. Percutaneous endoscopic gastrostomy does not prolong survival in patients with dementia. Arch Intern Med 2003;163: 1351e3.
  175. Callahan CM, Haag KM, Weinberger M, Tierney WM, Buchanan NN, Stump TE, et al. Outcomes of percutaneous endoscopic gastrostomy among older adults in a community setting. J Am Geriatr Soc 2000;48: 1048e54.
  176. Sanders DS, Carter MJ, D'Silva J, James G, Bolton RP, Bardhan KD. Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol 2000;95:1472e5.
  177. Abuksis G, Mor M, Segal N, Shemesh I, Plout S, Sulkes J, et al. Percutaneous endoscopic gastrostomy: high mortality rates in hospitalized patients. Am J Gastroenterol 2000;95:128e32.
  178. Mitchell SL, Kiely DK, Lipsitz LA. The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment. Arch Intern Med 1997;157:327e32.
  179. Meier DE, Ahronheim JC, Morris J, Baskin-Lyons S, Morrison RS. High short- term mortality in hospitalized patients with advanced dementia: lack of benefit of tube feeding. Arch Intern Med 2001;161:594e9.
  180. Nair S, Hertan H, Pitchumoni CG. Hypoalbuminemia is a poor predictor of survival after percutaneous endoscopic gastrostomy in elderly patients with dementia. Am J Gastroenterol 2000;95:133e6.
  181. Alvarez-Fernandez B, Garcia-Ordonez MA, Martinez-Manzanares C, Gomez- Huelgas R. Survival of a cohort of elderly patients with advanced dementia: nasogastric tube feeding as a risk factor for mortality. Int J Geriatr Psychiatry 2005;20:363e70.
  182. Jaul E, Singer P, Calderon-Margalit R. Tube feeding in the demented elderly with severe disabilities. Isr Med Assoc J 2006;8:870e4.
  183. Peck A, Cohen CE, Mulvihill MN. Long-term enteral feeding of aged demented nursing home patients. J Am Geriatr Soc 1990;38:1195e8.
  184. Teno JM, Gozalo PL, Mitchell SL, Kuo S, Rhodes RL, Bynum JP, et al. Does feeding tube insertion and its timing improve survival? J Am Geriatr Soc 2012;60:1918e21.
  185. Dasgupta M, Binns MA, Rochon PA. Subcutaneous fluid infusion in a long- term care setting. J Am Geriatr Soc 2000;48:795e9.
  186. Frisoli Junior A, de Paula AP, Feldman D, Nasri F. Subcutaneous hydration by hypodermoclysis. A practical and low cost treatment for elderly patients. Drugs Aging 2000;16:313e9.
  187. Turner T, Cassano AM. Subcutaneous dextrose for rehydration of elderly patientsean evidence-based review. BMC Geriatr 2004;4:2.
  188. Faes M, Spigt M, Olde Rikkert MGM. Dehydration in geriatrics. Geriatr Aging 2007;10:590e6.
  189. Sasson M, Shvartzman P. Hypodermoclysis: an alternative infusion tech- nique. Am Fam Physician 2001;64:1575e8.
  190. Slesak G, Schnurle JW, Kinzel E, Jakob J, Dietz PK. Comparison of subcu- taneous and intravenous rehydration in geriatric patients: a randomized trial. J Am Geriatr Soc 2003;51:155e60.
  191. Bruera E, Hui D, Dalal S, Torres-Vigil I, Trumble J, Roosth J, et al. Parenteral hydration in patients with advanced cancer: a multicenter, double-blind, placebo-controlled randomized trial. J Clin Oncol 2013;31:111e8.
  192. Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced dementia. J Am Geriatr Soc 1999;282:1365e70.
  193. Pasman HR, Onwuteaka-Philipsen BD, Kriegsman D, Ooms ME, Ribbe MW, van der Wal G. Discomfort in nursing home patients with severe dementia in whom artificial nutrition and hydration is forgone. Arch Intern Med 2005;165:1729e35.
  194. McCann RM, Hall WJ, Groth-Juncker A. Comfort care for terminally ill pa- tients: the appropriate use of nutrition and hydration. J Am Geriatr Soc 1994;272:1263e6.
  195. Musgrave CF, Bartal N, Opstad J. The sensation of thirst in dying patients receiving i.v. hydration. J Palliat Care 1995;11:17e21.
  196. Casarett D, Kapo J, Caplan A. Appropriate use of artificial nutrition and hydrationefundamental principles and recommendations. N Engl J Med 2005;353:2607e12.
  197. Mitchell SL. A 93-year-old man with advanced dementia and eating prob- lems. JAMA 2007;298:2527e36.
  198. Palecek EJ, Teno JM, Casarett DJ, Hanson LC, Rhodes RL, Mitchell SL. Comfort feeding only: a proposal to bring clarity to decision-making regarding dif- ficulty with eating for persons with advanced dementia. J Am Geriatr Soc 2010;58:580e4.
  199. Geppert CM, Andrews MR, Druyan ME. Ethical issues in artificial nutri- tion and hydration: a review. JPEN J Parenter Enteral Nutr 2010;34: 79e88.

Cited by

Sorted by citations

Authors
Volkert, D., Chourdakis, M., Faxen-Irving, G., Frühwald, T., Landi, F., Suominen, M. H., Vandewoude, M., Wirth, R., & Schneider, S. M.
Affiliations
  • Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
  • Klinik Hietzing (AT)
  • Università Cattolica del Sacro Cuore (IT)
  • Helsinki University Hospital (FI)
  • University of Antwerp (BE)
  • Centre Hospitalier Universitaire de Nice (FR)
Corresponding author
Volkert, Dorothee
ORCID
Venue
Clinical Nutrition
Publisher
Elsevier BV
Published
2015-12
Volume
34
Issue
6
Pages
1052-1073
ISSN
0261-5614 (ISSN-L)
DOI
10.1016/j.clnu.2015.09.004
OpenAlex
W1802951891
Cited by
442
References
14
Citations by year
2026: 23 · 2025: 34 · 2024: 57 · 2023: 44 · 2022: 55 · 2021: 43 · 2020: 52 · 2019: 57 · 2018: 40 · 2017: 24 · 2016: 11 · 2015: 2
FWCI
18.94
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
Funders
Sackler Faculty of Medicine, Tel-Aviv University
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
dementia, malnutrition, dietary management, older adults, malnutrition screening, weight monitoring, oral nutritional supplements, artificial nutrition, enteral nutrition, cognitive decline, dietary supplementation, nursing support, individualized care
MeSH terms
Aged, Appetite, Cognition Disorders, Dementia, Humans, Nutritional Status, Weight Loss, Fatty Acids, Omega-3, Randomized Controlled Trials as Topic, Treatment Outcome, Disease Progression, Nutritional Support, Nutrition Policy, Micronutrients, Evidence-Based Medicine, Dietary Supplements, Malnutrition

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