Elsevier

Clinical Nutrition

Volume 34, Issue 6, December 2015, Pages 1052-1073
Clinical Nutrition

ESPEN Guideline
ESPEN guidelines on nutrition in dementia

https://doi.org/10.1016/j.clnu.2015.09.004Get rights and content

Summary

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.

Keywords

Guideline
Dementia
Malnutrition
Nutritional support
Nutritional interventions

Abbreviations

AD
Alzheimer's disease
APOE
apolipoprotein E-e4 allele
DHA
docosahexaenoic acid
EPA
eicosapentaenoic acid
MCI
mild cognitive impairment
MNA
mini nutritional assessment
MNA-SF
mini nutritional assessment short form
MMSE
mini mental state examination
RCT
randomized controlled trial

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