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Preventing & Managing Cognitive Decline The number of New Zealanders with dementia is projected to increase over the next 30 years from 70,000 in 2020 to 170,000 by 2050 1.
LEIGH O'BRIEN NZ Registered Dietitian
he increasing prevalence affects all ethnic groups, with the number of Maori, Pacific people and Asians being diagnosed with dementia is also likely to increase. Dementia is an incredibly destructive disease that puts a considerable strain on those with dementia, their friends and family, and the health care system.
Managing modifiable risk factors to prevent dementia Diet and lifestyle make up five of the 12 modifiable risk factors outlined in the 2020 Lancet commission report on dementia prevention, intervention and care 2. These include managing high blood pressure, obesity, alcohol intake, diabetes, and physical inactivity. So essentially, what benefits the heart is also beneficial for the brain. For those under 70 years, eating more seafood, legumes, and nuts as the main source of protein is advised with one-two red meat meals a week. For adults over the age of 70, protein becomes more important and should be encouraged at every meal; the recommendations of reducing meat are likely to be less important. On diagnosis of dementia, nearly 50 percent have lost weight in the previous year. Weight loss may be a consequence of dementia due to increases in the resting metabolic rate caused by increased βamyloid deposition. Additionally, weight loss can cause changes that lead to or accelerate the development of dementia through the loss of lean body mass (muscle loss), resulting in inflammation occurring in the brain. Either way, being aware of changes in body weight could be a key indicator of the onset of dementia. Preventing ongoing weight loss will be incredibly important to ensure no further loss
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of muscle occurs. Muscle loss can lead to loss of balance, impacting activities of daily living (ADLs), loss of appetite, increased frailty and development of sarcopenia. Maintaining weight and encouraging exercise will help to maintain muscle and reduce inflammation.
Managing mild-moderate cognitive decline Dementia may lead to some older adults eating more and some eating less. Those eating less are often still hungry but have reduced insight into the need to eat. Residents may do best if there are minimal distractions. Too many items on a table or too many food choices at once can increase confusion. Some care homes serve the main meal and dessert simultaneously; this should be discouraged as it can be confusing and lead to only a small amount of the main course eaten – who wouldn’t want their dessert first if it was served at the same time. An interesting study serving adults with dementia meals on coloured plates found that the contrast of food against the plate increased food intake by 25 percent 3. If cognition affects the ability to use utensils, finger foods such as sandwiches, cooked vegetables, meat cut into pieces, boiled eggs, and cut-up fruit can replace main meals. Many adults with dementia need prompting, and some need visual cues of others eating to remind them to eat. Eating small, nutrient-dense meals may be required, such as nourishing soups, smoothies and even desserts. Nutritional supplements are often necessary to help meet calorie and nutrient requirements. If used, best served between or after a meal, so there is no effect on appetite at mealtimes.
