Dementia caregivers take on a huge responsibility when caring for a loved one with Alzheimer’s disease and dementia. Unfortunately, even the most dedicated will struggle with mealtime.

Weight Loss and Dementia

There are many reasons why weight loss occurs in people with Alzheimer’s disease and dementia—some even scientists don’t fully understand.

About 40% of all people with dementia experience significant weight loss. Despite popular belief, it’s not all about memory and nutrition. Physiology plays an important role, and in the case of Alzheimer’s disease, brain cells.

Both Alzheimer’s and dementia are progressive diseases, and because the brain regulates hunger through a complex system of hormones and chemicals, one’s appetite and tastes change as the disease progressives.

In the person with dementia, the sense of taste often diminishes over time. Favorite foods may no longer be appealing. Vision may become impaired, making is more difficult to locate food on the plate. Fine motor skills decline, making the physical act of eating more challenging. Sense of smell wanes, reducing the effects of sweet and savory aroma molecules on the appetite.

Many people with dementia lack appetite or the ability to interpret hunger. In later stages, they may struggle to chew or lack the motor skills required to hold utensils.

All of these add up to a dangerous weight loss spiral in the person with dementia and Alzheimer’s disease.

Why Do People With Dementia Lose Weight?

While there are many contributing factors, the cognitive and behavioral changes, hormone dysregulation and sensory dysfunction in the body and brain all converge to disrupt appetite, leading to weight loss in people with dementia.

Various reasons for weight loss in people with Alzheimer’s disease and dementia include:

• Medications. The side effect of medications used to ease the symptoms of dementia and Alzheimer’s disease may cause unwanted weight loss.
• Medical Conditions. Coexisting medical conditions such as depression, diabetes, thyroid disease, constipation, cancer, dysphagia, heart and kidney disease and even dental issues can cause weight loss.
• Behavioral Disorders. Easily overwhelmed and frustrated due to changes in the brain, common dementia symptoms can prevent people from getting proper nutrition while demanding larger amounts of energy. 
• Cognitive Changes. Neurological symptoms such as memory loss and confusion occur when communication networks in the brain are damaged or destroyed. For this reason, people with dementia often forget to eat and drink or recognize the food on the plate. 
• Hormone Dysregulation. When the body need nourishment, neurotransmitters are released, sending messages to the brain that signal hunger and stimulate appetite. When brain cells are compromised by dementia, the chemicals and hormones of the hypothalamic system are disrupted.
• Sensory Dysfunction. Changes in visual and spatial abilities and diminished gustatory perception (taste) discourage eating. Food on the plate may be difficult to see or smell differently.

The cascading effect of progressive brain disease can alter the nervous and endocrine systems as well as other essential functions of the body, including those that impact taste and other senses.  

The Sensory Nervous System and Alzheimer’s Disease

Alzheimer’s disease changes the brain in many ways and interferes with the complex systems that regulate the human sensory system, including vision, hearing, somatic sensation (touch), taste and olfaction (smell).

In the person with Alzheimer’s disease, molecular and cellular changes in the brain block essential brain neurons (nerve cells) and damage their synaptic connections. According to The National Institute on Aging, these neurons are essential to healthy brain function and a major factor in the central nervous system.

The result? Feelings associated with hunger are no longer interpreted by the brain the same way they were in the healthy brain. Each of the five senses—sight, hearing, smell, taste and sense of touch—are dramatically affected in the person with dementia and Alzheimer’s disease.

Those affected may not realize that they’re feeling agitated or sleepy due to low blood sugar or skipped meals. They may not recognize the smell of a favorite food. They may not be able to hold a fork or a spoon. Or they may not even see the food on the plate well enough to eat it.

Sensory Dysfunction Caused By Dementia

Vision, for instance, serves an important role in reducing weight loss. As early as 2004, researchers from Boston University correlated the level of food intake to visual-cognitive deficiencies in people with dementia. The breakthrough findings from the “red plate study” led to the introduction of brightly colored flatware and other products that use color to assist with eating.

The red plate study findings suggested that people with Alzheimer’s disease will eat 25% more food on a red plate than on a white plate!

Modifications to the environment, meal preparation and delivery are also used to increase appetite and reduce weight loss caused by dementia.

Dementia can interfere with the human sensory system in various ways:

• Vision and Dementia – People with Alzheimer’s disease and dementia struggle to process visual data, including contrast and depth perception.
• Smell and Dementia. Sense of smell is often diminished, further contributing to weight loss. The aroma of a pie baking or roast may not smell as good as it once did.
• Touch and Dementia. People with Alzheimer’s disease and dementia may lack motor coordination and making the physical act of eating difficult and frustrating, further derailing eating.
• Taste and Dementia. When taste sensitivity declines, people with Alzheimer’s disease are less likely to eat food they once enjoyed, ultimately leading to nutritional deficiencies and loss of body mass.
• Hearing and Dementia. While not as obvious a connection as the other senses, distracting noise can deter and disrupt an eating routing in a person with dementia.

Dementia caregivers often find it necessary to adapt food choices and eating strategies to meet a person’s changing needs, preferences and abilities and offer higher calorie items more frequently to help them maintain a healthy weight.

While there is still much to learn about the relationship between Alzheimer’s disease and weight loss, leading memory care communities incorporate the latest science and research into innovative dining programs for better nutritional outcomes.

For example, Bravo Dining by Serenades Memory Care helps residents maintain a healthy weight by engaging all five senses.

Bravo Dining at Serenades

As part of Bravo Dining, certified dementia caregivers at Serenades Memory Care are trained to leverage the powerful sense of smell, sight, hearing and taste to encourage eating and better nutrition.

Special techniques are used to trigger neuron connections in the brain and reinforce the connection between hunger and eating, including:

• Domestic kitchens and dining rooms to minimize stimulation. Large dining rooms have been linked to reduced food intake and weight loss.
• Higher calorie food choices to help maintain weight.
• Colorful dishware and placemats to create color contrast and help food stand out on the plate
• Smaller food portions to reduce anxiety caused by a crowded plate.
• Offer favorite foods and choices to appeal to changing preferences.
• Offer frequent snacks and lots of choices to increase feeding opportunities and nutritional intake.
• Aromatherapy, including use of essential oils and scented washcloths to engage the sense of smell.
• Family-style meal prep which serve food out of pots to stimulate appetite and get the gastric juices flowing.
• Serve warm foods. Waiting for food to cool might be a deterrent to eating.
• Limit utensils to one or service meals in a mug to minimize frustration caused by loss of motor skills.
• Chop food into smaller bites or serve one food at a time and offer finger foods to help coordination challenges.
• Play calming music during mealtime to minimize any anxiety and frustration caused by eating difficulties.
• Offer finger foods such as fish sticks or chicken nuggets to combat coordination challenges.
• Offer soft foods such as applesauce, cottage cheese, yogurt and pudding to mitigate chewing and swallowing challenges.
• Reduce and remove distractions such as TV and radio.