Many people with Alzheimer's disease Alzheimer's disease
A neurological disease that affects memory and behaviour. It is characterized by beta-amyloid plaques and neurofibrillary tangles in the brain. There is no known cause but genetics and lifestyle are thought to play a role., or with any dementia that advances to the severe stage, experience difficulties with eating. Like many other declines in function, when it occurs, it tends to follow a reasonably predictable course.

Typically, signs of problems with eating begin in the late moderate to the severe stage of Alzheimer's disease, by which time the person with dementia needs help with other basic activities, such as getting dressed.

In Alzheimer's disease, an early sign of problems with eating is difficulty in being able to use the utensils. This goes with less care being paid to table manners. These problems progress, so that the person needs to have their food cut up for them. As things worsen, the best that they can manage is to eat messily - usually slowly - with a spoon. Sometimes at the same time, but more commonly later, families notice that the person they care for is having problems getting the food to their mouth. A bib is soon needed.

The later parts of problems eating typically begin with the person requiring to be fed. Often this takes a lot of work, as the person is slow, needs to be prompted and their eating is uncoordinated (the technical term that doctors use for this is "apraxic", while "uncoordinated" is used to mean something else, but it is close enough for here). Another sign that families often notice at this stage is that the person they care for has problems once the food is in their mouth, to swallow. Instead of moving the food to the back of the mouth and swallowing, it tends to get pocketed to one side of the mouth. The food sits there, as if in a pouch, and the instinctive reaction is to push the outside of the cheek so as to move the food to the centre/back of the mouth, where the swallowing reflex can start.

Even later in the course of the illness, other problems with swallowing occur. The person can choke on food, due to uncoordinated swallowing arising as a consequence of impairment of parts of the brain and nervous system that are involved in swallowing. in some jurisdictions, this is seen as a medically manageable problem. What happens is that some health care professional will ask for a "swallowing assessment". These assessments involve a health care professional, who often is someone called a "speech and language pathologist". That person might work alone, but commonly works with a nurse and a dietitian in a swallowing assessment team. They watch the person be fed, and usually will ask for an x-ray X-ray
A type of high energy radiation that can be used to take pictures inside the body. assessment. Commonly, the x-ray assessment will reveal that the person with dementia has uncoordinated swallowing to the extent that food winds up in their lungs. The team will then suggest that the food fed to the person be minced, pureed, or slurried. Often too, they will suggest that it is safer for the person with dementia to be fed by a tube.

While that is the norm in some places, it is not done at all in others. Indeed, the issue is one of some controversy, with people who are against swallowing assessments in dementia pointing out that their value in prolonging life has not been demonstrated. Skeptics also worry that, especially in nursing homes and hospitals, the only thing worse than the usual institutional diet, is the usual pureed institutional diet. Whether to follow the route of swallowing assessments and what follows is a complex issue and source of controversy. Generally, if the person you care for is working with a health care team that does swallowing assessments, the tendency will be to have one done, and it will be hard to argue against it. On the other hand, if you are working with a team that tends not to do them, it will be hard to argue for them to actually do one.

One important point to remember is that if the person you care for refuses to eat, stops eating or eats slowly, it may be because of physical difficulties with the eating process. These can be detected without a formal swallowing assessment, but with an examination as to whether problems with chewing or swallowing are due to the damage in the brain, or because of sore gums, dentures, or some other problem in the mouth itself. Another important point is that when people with dementai become ill from some other medical cause - such as pneumonia Pneumonia
Inflammation of the lungs that results after bacterial, viral or fungal infection., or a heart attack Heart attack
When there is not enough blood getting to a certain area of the heart, that portion of the heart does not receive enough oxygen and dies. - they often will have a short period of up to two weeks, when swallowing becomes impaired. It can then recover, but if a swallowing assessment is carried out during the time of the transient problem, the person is condemned to a slurried diet.

Where swallowing assessments most clearly have a role is for the person who has had a stroke Stroke

Blood supply to the brain is interrupted, usually by a blood clot. As a result, a portion of the brain can die from not receiving enough blood and oxygen.