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Eating | Common Signs

  • Refuses to open their mouth
  • Refuses to chew
  • Refuses to swallow
  • Has difficulty chewing
  • Has difficulty swallowing
  • Needs assistance with feeding
  • Needs prompting when eating (e.g. to pick up utensils, put food in their mouth)
  • Has difficulty telling temperature of food (e.g. hot and cold)
  • Eats very slowly
Eating | General Description

Many people with Alzheimer's disease , 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 dietician in a swallowing assessment team. They watch the person be fed, and usually will ask for an x-ray 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 dementia become ill from some other medical cause - such as pneumonia , or a heart attack - 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 , and whose impairment with swallowing is judged likely to be temporary. In such cases, it is much less controversial to place a feeding tube for a short time period to improve nutrition. The evidence is less clear about whether this actually decreases the risk of pneumonia due to aspiration, which is another of the benefits promoted for tube feeding in the setting of dementia.

As Frontotemporal dementia primarily impairs the part of the brain responsible for social conduct skills, the person can show bizarre social behaviour which can include eating. For example, some people with Frontotemporal dementia tend to overeat or to excessively consume liquids, or alcohol or cigarettes. They can become fixated on sweet foods, so that often weight gain results. They may also have dietary compulsions, so that they will eat only specific foods. In the late stages , the person may become orally fixated and attempt to put inedible objects into his/her mouth.

Problems with eating can be seen in Parkinson's disease dementia, in other dementias with parkinsonism - such conditions as multiple systems atrophy , supranuclear palsy, or corticbasal degeneration , in Dementia with Lewy Bodies , and in more advanced vascular dementia in association with changes in their facial expression.

The first step in taking a more active role in symptom management is understanding how a symptom is affecting everyday life; the next step is communicating this knowledge to the care planning team and family members. SymptomGuideTM is designed with these goals in mind.

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See Also:
Symptom Library > Physical Changes > Physical Complaints
Symptom Library > Personality Changes > Low Self Esteem
Symptom Library > Physical Changes > Sensory Input
Symptom Library > Personality Changes > Independence
Symptom Library > Thinking & Judgment > Following Instructions
About Dementia > Alzheimer's Disease > Apraxia
About Dementia > Alzheimer's Disease > Agnosia
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Last updated January 15, 2019
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