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Dementia and Weight Loss

Introduction

Weight loss is another of those unexpected side-effects that you may witness in your loved ones suffering from dementia.

As you are probably aware, at times, dementia can be an energy-consuming as well as a mentally challenging disease for all the family. One of the most common factors which can be intimidating for many is the weight loss associated with this condition. 

What is Weight Loss? 

Weight loss is considered when a patient fulfills any of the following criteria

• Weight loss of up to 5% of total body weight
• An unexpected decrease in weight for three months consecutively

There can be many reasons for this loss or decrease in weight. Some seem very obvious, while some are quite rarely heard of. The main goal here is to make sure that you are able to help the dementia sufferer stay healthy and be able to fight off any sort of disease with having adequate weight.

Causes of Weight Loss in Dementia

• Eating less: One of the most common causes of weight loss is eating less than required. According to research, around 76% of dementia patients need to be fed as they are unable to do so on their own. This leads them to be more dependent and eventually decreasing the food intake further. The eventual result is the weight drastically going down.
• Medical problems causing weight loss: If you have any other disease, together with dementia, weight loss may only worsen. Diseases like hyperthyroidism and diabetes can act as a catalyst for weight loss due to dementia.
• Use of Medications: If you are using any medications, for any illnesses, it can also be the causative factor for weight loss. In the case of comorbid conditions, these medications decrease either appetite or body mass while treating the primary disease, hence adding to the weight loss
• Psychological Cause: Dementia is already a cause of stress for an individual. An additional weight loss will only increase the mental stress which will further lead to a decrease in appetite, and a vicious cycle of weight loss ensues.
• Physical pains: You can experience pain in different parts of the body associated with dementia. These pains will cause either a decrease in appetite or the usage of medications for pain, which eventually will lead to weight loss in the long term.
• Decreased fluid intake: Not drinking enough fluids is yet another established cause of weight loss. Our body mostly consists of water, which is needed for all the bodily functions. If you decrease the water intake, the primary body functioning is altered, resulting in further weight loss
• Special diets: If you are very particular about eating only a specific food item, then you may have to revise your diet chart. Eating a diet that contains only a specific group of nutrients causes weight loss to worsen, e.g. If you have diet lacking cholesterol or good fats, your body will be deprived of the essentials for tissue regeneration even though you are eating a lot.
• Chronic Infections: If you have an added chronic infection, in addition to dementia, then weight loss is not something out of the question to happen. Chronic infections attack the body’s immune system so much that it can go beyond the point of repair and nobody mass is formed eventually. 
• Cachexia: One of the most serious complications you may experience due to chronic weight loss in advanced dementia is a condition called cachexia. This condition occurs as a result of chronic weight loss, and the body comes to a point where no nutrients are absorbed. At this point, even if you eat or drink adequately, the body won’t be able to absorb any of the nutrients.
• Being Judgmental: If you are a carer for dementia patients, make sure that nobody judges them for any point they make. Most of the patients get defensive, and it leads to further psychological stress. Furthermore, they would stop expressing themselves which can make the weight loss even worse.
• Loss of general sensation: You may experience loss of general feeling which is usually associated with dementia. This can lead to a decrease in appetite and eventually loss of weight.
• Dementia stage: Different stages of dementia cause a diversifying degree of weight loss. The mild form of dementia will cause weight loss to be insignificant as compared to the advanced stage.

Although the causes might look a bit disturbing, the solutions are quite simple in most of the cases. You can find what suits you from the following list and incorporate it into your lifestyle to address the weight loss problem. 

How to Prevent Weight Loss in Dementia Patients

• Eat food of choice: Try eating the food of your choice as the smell and taste of that specific food will stimulate your appetite. Also, altering food groups helps in increasing appetite as well as weight gain. 
• Oral Nutritional Supplements: ONS is very helpful in increasing weight, assisted with increased nursing time and proper care. ONS includes soft, pureed gratin/Reformed minced diet. Lyophilized (freeze-diet) food products have also been found effective
• Social feeding: Eating with family members helps boost appetite. Hence, it helps encourage you to eat. A study showed that positive tactile feedback by the carer improved feeding in dementia patients.
• Never force someone to eat: Of all the things you can do, this should be something which should never be considered. Force-feeding can damage you psychologically and physically too, and in turn, will do more harm than benefit
• Regular follow-ups: This should be a mandatory task documented in your diary and never be missed. This will help you in understanding your current condition as well as to identify any issue at an early stage.
• Impaired autonomy: Imagine a person fully independent all his/her life, gradually hit by a debilitating disease, being unable to do simple tasks even. They would definitely be not happy, depending on others. As a carer, having empathy is of paramount importance.
• Environmental changes: Changing the surrounding, the settings of the dining hall, etc. are also helpful in encouraging them to eat.
• Physical Activity: Being active is essential not only for your physical wellbeing but also to improve your dietary habits. Getting yourself involved in daily activities will help you counter weight loss by keeping you physically and mentally strong.
• Setting up an eating timetable: Having a scheduled eating time is very important to boost your eating habits. In dementia, if Research shows that setting up a specific eating pattern helps in improving the appetite and increase the weight
• Assisted eating: Since most of the dementia patients require support in daily activities, assisted eating is quite helpful. This helps strengthen social contact as well as make the patient eat well while staying in the comfort zone
• Artificial feeding: If you are unable to swallow food and eat properly, this technique can be helpful for you to increase weight. It includes tube feeding whereby food is directly put in the gullet, bypassing the oral cavity. Although it seems to be the preferred choice but research discourages it due to complications it carries.

Conclusion

Weight loss in dementia can be treated with a multidisciplinary approach, including food fortification, nursing care, nutritional supplements and above all, social support. Family support and dementia support groups are quite helpful in this regard. If, even after trying my recommendations, there is no weight gain, then consult your dementia nurse or General Practitioner who can guide you further

References

• Abdelhamid A, Bunn D, Copley M, Cowap V, Dickinson A, Gray L, Howe A, Killett A, Lee J, Li F, Poland F. Effectiveness of interventions to directly support food and drink intake in people with dementia: systematic review and meta-analysis. BMC geriatrics. 2016 Dec;16(1):26.
• Bunn DK, Abdelhamid A, Copley M, Cowap V, Dickinson A, Howe A, Killett A, Poland F, Potter JF, Richardson K, Smithard D. Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review. BMC geriatrics. 2016 Dec;16(1):89.
• Herke M, Fink A, Langer G, Wustmann T, Watzke S, Hanff AM, Burckhardt M. Environmental and behavioral modifications for improving food and fluid intake in people with dementia. Cochrane Database of Systematic Reviews. 2018(7).
• Jones S. Nutritional interventions for preventing malnutrition in people with dementia. Nursing older people. 2019 Sep 27;31(5).
• Testad I, Kajander M, Froiland CT, Corbett A, Gjestsen MT, Anderson JG. Nutritional Interventions for Persons With Early-Stage Dementia or Alzheimer’s Disease: An Integrative Review. Research in gerontological nursing. 2019 Sep 24;12(5):259-68.
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