Dementia News & Events

In 2007, a 23-member nationwide expert panel drawn from French geriatricians released guidelines for assessment and management of weight loss in Alzheimer's patients.  They had been provided a detailed literature review and invited to attend a series of discussions and meetings on the topic prior to reaching consensus on a set of guidelines.

THE GUIDELINES:

NUTRITIONAL ASSESSMENT OF ALZHEIMER'S DISEASE PATIENTS:

• Nutritional status must be assessed at the time of diagnosis and/or the start of treatment.
• Nutritional assessment comprises at least: weighting and the Mini Nutritional Assessment (MNA) carried out with the help of the family caregiver.
• Nutritional follow-up comprises at least monthly recording of weight, carried out on the same conditions and using the same scales, at home or in the institution, with the help of a family or professional caregiver if necessary.
• When consulting his/her physician or if admitted to hospital, every Alzheimer disease patient must be weighed and loss or weight must be sought.
• Weight loss of 2kg or more as compared to baseline weight and/or anorexia must alert the caregivers and require nutritional assessment done by the physician.
• Nutritional intervention must be started if weight loss of 5% or more has occurred in 3 to 6 months.
• Nutritional intervention must be started if two (or more) of the following criteria are met: MNA score <17, plasma albumin <35 g/L, decrease in food intake assessed during 3 days. 
• When treated with acetyl cholinesterase inhibitors (ACE), the onset of anorexia and/or weight loss requires immediate search for cause other than ACE treatment.

NUTRITIONAL INTERVENTION

• Comprises search for reversible medical or socio-environmental causes, increase calorie/protein intake (oral supplementaion by food and or dietary supplements) and daily physical activity.
• At the severe stage with weight loss, anorexia or malnutrition, there is no benefit in starting artificial nutrition (enteral or parenteral).
• Some situations involving medical stress (surgery, servere infection) systematically require nutritional support

PREVENTION AND EDUCATION

• Varied and balanced diet and daily physical activity must be recommended to prevent weight loss and nutritional risks.
• Prevention of dehydration.
• Healthcare professional and family caregivers must follow training courses on the food/diet and signs of nutritional risk.

FOR MORE INFORMATION
Practical guidelines for the diagnosis and management of weight loss in Alzheimer's disease: A consensus from appropriateness ratings of a large expert panel. Belmin J. et al The Journal of Nutrition, Health & Aging Vol 11, N.1 2007 (33-37) http://www.serdi-fr.com/jnha/page2.php?id=208