Describe about the Promoting Nutrition in Dementia Patients for A Literature Review.
Dementia is a mental condition that considerably hinders the daily life of individuals. This clinical condition is manifested by the complications like impaired memory, communication problem, inattentiveness, disturbance in visual perception and reasoning. Dementia develops with mental deterioration and factors like diet and exercise extend considerable influence on the progression of this disease among the affected individuals. Elderly people are the greatest victims of dementia and their mental condition deteriorates due to nutritional inadequacies that require the earliest mitigation for normalizing their lives across the community environment. This literature review explores the nutritional causes of dementia and identifies the evidence-based dietary interventions for effectively treating the clinical manifestations of this complex mental condition. The requirement of enhancing the nutritional status of the demented patients emphasized throughout the length of the literature review in the context of improving their quality of life and mental health outcomes. The literature review effectively explores the pattern of relationship between the quality of life of demented patients and their nutritional requirements in the context of formulating appropriate dietary interventions for mitigating the intensity of their mental symptoms. The focus of this literature review attributes to the exploration of nutritional strategies while including various macronutrients and micronutrients in the diet of the demented patients for reducing the intensity of their cognitive decline. The literature review further explores the therapeutic benefits of vitamins E, B and C and other antioxidants in the context of improving the mental health outcomes of the individuals affected with the pattern of dementia. The literature review focuses on the requirement of developing behavioural and feeding interventions for the demented patients in reducing their feeding dependency and associated pattern of undernutrition and weight loss experienced by them across the community environment. The literature review also emphasizes the requirement of the effective modification of the mealtime environment of the elderly individuals in the context of reducing their predisposition towards the development of dementia and its associated mental manifestations.
Literature Search Strategy
This literature search utilized CINAHL database because of its comprehensive attributes and wide utilization by the research community. The search term “nutrition in dementia” generated 24, 567 results and therefore, Boolean settings were utilized for incorporating multiple keywords like “Dementia prevention”, nutritional causes of dementia” and “dementia prophylaxis” while searching for the relevant peer reviewed articles matching with the subject of study. Filters were applied to effectively segregate the primary research articles with the secondary ones in the context of their inclusion in the literature review. Indeed, 34 research studies qualified the requirements of the subject of interest in accordance with the credibility findings, bias, confounding factors and study theme. NMC code of conduct and Anglia Ruskin University portal was utilized in searching the evidence – based content matching with the theme of the study.
Dementia - The Nutritional Context
The research findings by (Rossor et al., 2010) indicate dementia as a major public health concern that affects individuals with their age advancement. The pattern of dementia adversely affects the cognitive as well as occupational functioning of the affected patients. This disease influences the patients of age range 30 – 65 years; however, the prevalence of the disease recorded among the elderly individuals. The findings by (Swaminathan & Jicha, 2014) indicate the sustained deficiency of caprylic acid as one of the several causes of the development of Alzheimer’s dementia in aged people. Therefore, treatment strategies for dementia patients require the administration of medical food and dietary regimen for accomplishing their nutritional deficits in the context of mitigating the symptoms of memory, reasoning, judgment and communication impairment (Swaminathan & Jicha, 2014). Evidence-based research literature advocates the high predisposition of the obese and malnourished individuals in terms of developing the patterns of Alzheimer’s dementia and associated psychosocial manifestations (Hu et al., 2013). Memory loss among the demented patients might occur due to thiamine deficiency arising from malnutrition (Ghosh, 2010). The deficiency of vitamin B – 12 in co-morbid states like celiac disease and pernicious anemia leads to the development of neuropsychiatric symptoms that deteriorate the mental health status of the demented patients (Ghosh, 2010). Research findings by (Thaipisuttikul & Galvin, 2012) indicate the attribution of metabolic deficiencies in the causation of Alzheimer’s dementia among the predisposed patients. These deficiencies arise because of dietary mismanagement and nutritional abnormalities among the affected patients. Nutritional inappropriateness also contributes to the development of memory decline and communication deficits among demented patients (Coppedè et al., 2012). Nutritional deficiencies during the early age facilitate the age related degeneration of human brain. Therefore, the sustained nutritional deficits among the elderly individuals increase their predisposition towards the development of dementia and its associated manifestations. Evidence – based research literature reveals the elevated risk of malnutrition among the patients affected with senile dementia and associated psychosocial manifestations (Volkert et al., 2015). This nutritional decline adversely influences the cognitive ability of elderly patients that deteriorates further due to the inappropriate dietary patterns and nutritional management strategies. The sustained deficits of micronutrients and vitamins C and E increase the oxidative stress in the brain that resultantly deteriorates the cognitive, learning and communication abilities of the demented patients (Santos et al., 2014). The research findings by (Polidori & Schulz, 2014) indicate the attribution of a defective antioxidant defense mechanism in the causation of dementia among individuals of various age groups. Various dietary vitamins and minerals are responsible for maintaining the antioxidant defense mechanism in the human body and therefore their sustained deficiency considerably increases the predisposition of individuals in terms of developing dementia and its associated clinical manifestations. The deficiency in β-carotene also deteriorates the cognitive performance and extends detrimental effects on the pattern of dementia among the affected individuals (Polidori & Schulz, 2014). The inappropriate administration of the selective serotonin uptake inhibitors inhibits the calcium uptake that resultantly elevates the risk of the individuals in terms of developing mental health problem (Rao et al., 2008)s. Similarly, the deficiency of chromium leads to the development of mental health issues in the affected individuals. The deficiencies of the nutrients like iodine, iron, lithium, selenium and zinc also promote the establishment of mental complications like dementia and other psychosocial conditions (Rao et al., 2008). The findings by (Gu & Scarmeas, 2011) indicate the lack of consumption of fruits, vegetables, legumes and nuts as the significant cause of the development of dementia and associated cognitive deficit. The evidence-based analysis by (Ramesh et al., 2010) reveals the high intake of alcohol and saturated fatty acids as one of the important causes of dementia and its cognitive manifestations. Similarly, the sustained deficiency of the methionine-rich proteins promotes the development of dementia and age associated learning and cognitive disabilities among the affected individuals. The adverse eating behavior of the demented individuals creates nutritional imbalance that further deteriorate their cognitive and mental conditions (Ramesh et al., 2010). The clinical findings in (Wald et al., 2011) indicate the attribution of the high levels of homocysteine in the establishment of dementia patterns among the elderly population. The elevated level of folate and vitamin – 12 along the with the high level of homocysteine increase the risk of the elderly patients in terms of developing Dementia and associated communication deficits (University_of_Oxford, 2007).
Dementia Prevention through Nutrition Promotion
The research findings by (Canevelli et al., 2016) reveal the potential advantages of various dietary interventions in terms of elevating the neuropsychological test scores of the demented patients. The Mediterranean diet including the mixed nuts and virgin olive oil assists the demented people in terms of enhancing the level of their cognition and memory (Canevelli et al., 2016). The inclusion of antioxidants in the diet of elderly individuals facilitates the reduction in inflammation that reciprocally reduces the scope of dementia establishment among the predisposed people (Middleton & Yaffe, 2009). The administration of polyunsaturated fatty acids through vegetables, fruits and fish decreases the risk of individuals of various age groups in terms of developing dementia and associated cognitive decline (Middleton & Yaffe, 2009). Research findings by (Dacks et al., 2014) advocate the significance of the pattern of daily walking and administration of the Mediterranean diet in terms of facilitating loss of weight among demented patients affected with obesity. Indeed, the administration of these integrated techniques assists in improving the quality of life as well as mental health outcomes of the demented patients. The evidence-based findings by (Eskelinen & Kivipelto, 2010) advocate the likelihood of the beneficial effects of caffeine administration on the mental health of individuals. Antioxidant capacity and other potential health advantages of caffeine require further exploration in the context of developing prophylactic interventions for reducing the establishment of dementia (Eskelinen & Kivipelto, 2010). Dementia in elderly patients is manifested by the accumulation of amyloid and tangles in the necrotic region of the human brain. The modification in the dietary habits of demented patients assists in reversing this abnormal accumulation leading to their subsequent reduction in cognitive decline and memory deterioration (Solomon et al., 2014). Evidence – based research literature describes coronary artery disease, diabetes mellitus, lipid problems and arteriosclerosis as the significant causes of vascular dementia among the elderly people (McVeigh & Passmore, 2006). Research findings by (Asif, 2014) advocate the requirement of administering cereals, nuts and fruits for enhancing the accumulation of dietary fibers and polyphenols that prevent the pattern of weight gain and assists in controlling the level of blood glucose in the diabetic patients. The reduction in blood glucose level resultantly reduces the predisposition of diabetic patients towards developing dementia and its associated mental health issues. The clinical findings in (Solfrizzi et al., 2011) reveal the protective effect of milk and dairy products in preventing the onset and establishment of dementia manifestations among the predisposed individuals. The evidence-based findings by (Wu et al., 2015) indicate the attribution of omega – 3 fatty acids in the causation of dementia among the elderly individuals. Therefore, increased intake of omega – 3 fatty acids through diet decreases the likelihood of aged people in terms of acquiring dementia and its clinical complications. Evidence-based findings by (Coppedè et al., 2012) indicate the positive implications of the concomitant administration of lifestyle and nutritional interventions on the age related cognitive impairment of the individuals. Systematization of dietary intake with the administration of exercise interventions helps in reducing the stress of individuals that eventually decrease the scope of over-nutrition, reduction in physical activity and the establishment of metabolic complications that enhance the likelihood of dementia establishment. The findings by (Coppedè et al., 2012) also indicate the high level of plasma triglyceride and reduced level of HDL among the demented individuals affected with blood-brain barrier impairment (BBBI). Therefore, the enhancement of HDL component in the diet of these patients assists in regularizing their lipid metabolism that significantly influences their mental health outcomes. The research findings by (Hanson et al., 2011) advocate the requirement of administration of oral feeding in demented patients in the context of improving their overall health status. The nurse professionals require the implementation of the NMC code of conduct during the administration of oral feed and should uphold the dignity of the demented patients while extending nutritional management for their health improvement (NMC, 2015). Assisted feeding through intubation might prove painful for the demented patients and predispose them towards the development of gastrointestinal complications. Therefore, the nurse professionals must practice necessary protective measures while administering nutritional support and assistance to the demented patients across the clinical setting. The concomitant administration of multinutrient supplementation and strategies for improving the quality of sleep of individuals extends protective effects on their brain that reduces their likelihood of acquiring dementia across the community environment (Yaffe & Hoang, 2013).
Dementia and Undernutrition/Weight Loss Mechanisms
The research findings by (Meijers et al., 2014) indicate the high prevalence of malnutrition among the dementia affected patients. Although, the pattern of weight loss advances with age progression; however, the establishment of dementia facilitates the weight loss mechanisms among the affected patients that prove to be the potential barriers in their care and treatment. Evidence-based research literature advocates the requirement of nutritional intervention for Alzheimer's disease patients who experience the weight loss of more than 5% within tenure of 3 – 6 months (Droogsma et al., 2015). Furthermore, nutritional assessment proves to be an important tool in determining the undernourished status of demented patients in the context of initiating nutritional management strategies for effectively improving their wellness outcomes. The clinical findings in (Pilleron et al., 2015) reveal the close association of the pattern of cognitive decline in undernutrition status of the demented individuals. The pattern of weight loss caused due to undernutrition reciprocally increases with the dementia stages. This confirms that the severity of dementia manifestations facilitates the progression of weight loss and associated health complications among the affected patients. The pattern of poor nutrition along with alcohol use leads to sustained thiamine deficiency among the demented individuals (Ridley et al., 2013). This thiamine deficiency facilitates the development of cerebellar dysfunction, oculomotor disorders and altered mental status manifested by the pattern of hemorrhagic lesions and neuronal loss during the course of dementia progression. The clinical findings by (Wu & Lin, 2015) indicate the potential deterioration in the mealtime performance of the patients in their late stages of dementia. Defective mealtime performance results in nutritional deficiencies among the affected patients that further leads to the progression of their clinical complications. This indicates the requirement of undertaking memory-training interventions for improving the eating capacity of demented patients. Indeed, improved eating capacity assists the demented patients in terms of overcoming the state of their undernutrition and associated adverse health outcomes. The research findings by (Chow et al., 2009) indicate the pattern of apathy experienced by the demented individuals across the community environment. This apathy results in the development of anorexia and disinterest in feeding leading to undernutrition that adversely influences the cognitive abilities of the affected individuals. The evidence-based findings by (Yildiz et al., 2015) indicate the episodes of hallucinations, delusions, agitation, insomnia, incontinence and immobility experienced by the demented patients under the influence of sustained undernutrition. These adverse episodes further deteriorate the feeding behavior of the affected patients that extends detrimental effects on their metabolic functioning and mental health.
Strategies for Nutritional Enhancement of Dementia Patients
The research findings by (Salvà et al., 2011) reveal the reduction in malnutrition risk of the demented patients following the administration of dietary and exercise interventions by trained nutritionists. Research subjects experienced the enhancement of autonomy and nutrition status and reduction in caregiver burden under the influence of the administered dietary approaches. The study by (Bunn et al., 2016) attempted to explore the effects of the interventions like family-style meals, improved the dining room, shared mealtime and enhanced in lightening and aroma of the dining rooms in elevating the nutritional status of the demented patients. The findings of the research study did not reveal concrete evidence regarding the advantages of administered environmental modifications in terms of improving the dietary pattern and nutritional state of the treated patients. However, prospective exploration of strategies highly warranted in the context of understanding their potential for improving the nutritional condition of the patients affected with dementia and its adverse mental manifestations. The randomized controlled trial by (Ngandu et al., 2015) attempted to investigate the advantages of the multidomain approaches attributing to cognitive training, dietary interventions, vascular risk monitoring and exercise strategies in terms of preventing the risk of cognitive decline and dementia among elderly patients. The findings of the study revealed the potential of these multidomain strategies for improving the cognitive functioning of the elderly individuals. This also confirms the effective contribution of dietary strategies for improving the mental health of the elderly patients who experience the risk of developing dementia across the community environment. However, prospective studies require execution in the context of exploring the potential of singly administered dietary interventions in improving the mental health status of the demented patients.
The findings of this literature research evidentially reveal the dietary factors that considerably elevate or decrease the predisposition of individuals towards the development of dementia and its associated mental manifestations. Important dietary constituents like vitamin B complex, vitamins E and C and omega – 3 polyunsaturated fatty acids offer a protective role for the elderly people who experience high risk of developing the pattern of dementia across the community environment. The findings also advocate the requirement of implementing various lifestyle modification strategies including exercise interventions and dietary management approaches for stabilizing the metabolic condition of individuals affected with dementia symptoms. The nurse professionals and other members of the healthcare teams must administer evidence-based feeding interventions to maintain the nutritional status of demented patients in the context of treating their symptoms of memory impairment and cognitive decline. Undernutrition among demented patients is a significant health concern requiring earliest intervention by nutritionists, physicians and nurses in the context of improving their health and wellness across the community environment. Healthcare professionals need to identify the attribution of the sustained nutritional deficits in the causation of dementia and its clinical manifestations among the predisposed individuals. The role of antioxidant defence mechanisms in improving the mental health status of individuals emphasized throughout the course of literature review. Furthermore, the dietary factors that adversely influence the mental health outcomes of demented patients emphasized and appropriate dietary interventions recommended accordingly for the effective enhancement of their cognition, learning and memory. The weight management as well as hypertension and hypercholesterolemia control strategies through nutritional interventions warranted in the context of decreasing the likelihood of elderly patients affected with BBBI towards the acquisition of dementia and its psychosocial manifestations. Indeed, the nutritional management strategies prove to be the significant tools in improving the mental health of the demented patients; however, the prospective research studies warranted for streamlining the integrated nutritional as well as pharmacotherapeutic approaches for reducing the burden of dementia across the community environment.
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