Malnutrition predicts faster functional loss in dementia patients

New research led by King’s College London and Stavanger University Hospital. highlights the importance of assessing malnutrition in people with dementia, in order to help slow loss of independence or functional decline.

The researchers call for a more rounded approach to dementia treatment, including nutritional assessments which detect malnutrition as early as possible, so that clinicians can take preventative action and ultimately improve outcomes for their patients.

Published today in the Journal of Alzheimer’s Disease, the study is one of the first to analyse the association between malnutrition and the course of cognitive and functional decline in people living with dementia.

Dementia is a common condition affecting more than 850,000 people in the UK. It can have a severe impact on daily life, and is a major cause of disability. People with dementia vary widely in how their condition progresses, and multiple factors can contribute to the course of cognitive, physical, and functional decline.

Nutrition, and in particular malnutrition, is emerging as an important and preventable factor related to cognitive decline (such as mental ability) and dementia. Malnutrition is a common condition in older adults living both within the community and in nursing homes, yet little is known about how it contributes to the progression of cognitive and functional decline.

Long-term cohort study

The researchers accessed a long-term cohort study called the Dementia Study of Western Norway, drawing on data from 202 patients diagnosed with mild dementia, including Alzheimer’s disease, Lewy body dementia and other types of dementia.

The degree of functional and cognitive decline shown by patients was measured through an analysis of various daily activities, including eating, making simple food, personal hygiene and mobility. Levels of malnutrition were defined using the Global Leadership Initiative on Malnutrition (GLIM) Index, which measures body weight, thinness and muscle mass.

The researchers found that malnutrition was present in more than a quarter of dementia patients (29%), and was associated with a more rapid functional decline over five years. The relationship with cognitive decline, on the other hand, was not statistically significant.

Importance of a balanced diet with the required nutrients

Dr Miguel Germán Borda, Medical Doctor and Geriatrician, PhD student at Centre for Age‐Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway. said: 

“Older persons and especially those with dementia for many reasons tend to eat less. It may be harder to maintain a balanced diet with the required nutrients. Carers or patients could speak to their doctors or a registered dietitian if they need advice about healthy eating. They could help to plan meals with nutrient-rich foods, increase healthy snacks, or check a patients recommended daily calorie intake.”

Professor Dag Aarsland, King’s College London’s Institute of Psychiatry, Psychology & Neuroscience (IoPPN) and the NIHR Maudsley BRC Dementia and Related Disorders research theme, said:

“Our results indicate that malnutrition is associated with faster functional loss, but not with cognitive decline, in older adults with dementia. We think malnutrition worsens function through its impact on the body’s muscles and immune system, mood, mobility and other aspects of physical and mental health. However, this relationship is likely to go in both directions – for example, functional loss generates barriers to food access and cooking, which could exacerbate malnutrition.

We need a more rounded approach to dementia treatment, including nutritional assessments which detect malnutrition as early as possible, so that clinicians can take preventative action and ultimately improve outcomes for their patients.”

This research was funded by the Norwegian government and the National Institute for Health Research (NIHR) Maudsley Biomedical Research Centre (BRC).

The paper was published in Journal of Alzheimer's Disease Volume (79) Issue (4).

Read the paper

Borda, Miguel Germán et al. ‘Association of Malnutrition with Functional and Cognitive Trajectories in People Living with Dementia: A Five-Year Follow-Up Study’. 1 Jan. 2021 : 1713 – 1722.

Notes to editors

Journal of Alzheimer's Disease (JAD)

Now in its 24th year of publication, the Journal of Alzheimer's Disease is an international multidisciplinary journal to facilitate progress in understanding the etiology, pathogenesis, epidemiology, genetics, behavior, treatment, and psychology of Alzheimer's disease. The journal publishes research reports, reviews, short communications, book reviews, and letters-to-the-editor. Groundbreaking research that has appeared in the journal includes novel therapeutic targets, mechanisms of disease, and clinical trial outcomes. The Journal of Alzheimer's Disease has a 2019 Journal Impact Factor of 3.909 according to Journal Citation Reports (Source Clarivate, 2020). JAD is published by IOS Press. www.j-alz.com