Nutrition for Dementia

Professional Research Presentation

Joyce Moon, MSN

Dietetic Intern
Sodexo Dietetic Internships
May 11, 2017
Before We Begin

A bit of flavanol for

your brain!
Objectives
Define dementia and neurodegenerative disease including
risk factors and S/Sx
Discuss the national, global and nutritional implications of
dementia
Review current literature on nutrition interventions for and
prevention of dementia
Overview
Facts and Figures
 Dementia Defined

The development of memory impairment and

other cognitive deficits severe enough to
decrease the affected persons capacity to
function at the previous level despite a normal
level of consciousness. It arises during the
course of many neurodegenerative diseases; it
can accompany numerous other diseases that
injure the cerebral cortex.

1. Kumar V, Abbas AK, Aster JC. Robbins basic pathology. 9th ed. Philadelphia, PA: Elsevier Saunders, 2013.
 Dementia Screening (FYI)

2. Sheehan B. Assessment scales in dementia. Ther AdvNeurol Disord. 2012; 5(6): 349-358.
 Dementia Characteristics
Insidious onset of impaired Higher cortical functions affected:
higher intellectual function and memory
altered mood and behavior
thinking
Progresses to disorientation, behavior
memory loss, aphasia indicative
of severe cortical dysfunction orientation
Early dementia: taste and smell comprehension
dysfunction, medications or major calculation
depression may trigger anorexia
and weight loss, but prolonged, learning capacity
irreversible feeding problems are
uncommon language
Over next 5-10 years, pt becomes judgment
profoundly disabled, mute, ability to perform everyday activities
immobile

1. Kumar V, Abbas AK, Aster JC. Robbins basic pathology. 9th ed. Philadelphia, PA: Elsevier Saunders, 2013.
 Common Symptoms and Stages of Dementia
EARLY STAGE (1-2 years)
Often overlooked; relatives and friends (professionals
as well) see it as "old age" - normal part of the ageing As disease progresses, limitations become clearer and more
process. Gradual onset of the disease makes it
difficult to pinpoint when it begins
Forgetful, especially things that just
happened
May have difficulty with communication,
i.e. difficulty in finding words
Become lost in familiar places
Lose track of the time (time of day,
month, year, season)
Difficulty making decisions and handling
personal finances
Difficulty carrying out complex
household tasks
Mood and behavior:
may become less active and
motivated, lose interest in
activities and hobbies
may shows mood changes,
including depression or anxiety
may react unusually angrily or
aggressively, on occasion
3. Hebert LE, Weuve J, Scherr PA, Evans DA. Alzheimer disease in the United States (20102050) estimated using the 2010 census. Neurology. 2013; 80: 17781783.
4. Karantzoulis S, Galvin JE. Distinguishing Alzheimers disease from other major forms of dementia. Neurother. 2014; 11: 15791591.
MIDDLE STAGE (2-5 years)
restricting
Forgetful, especially of recent events and
people's names
increasing difficulty with communication
(speech and comprehension)
May become lost at home as well as in the
community
Have difficulty comprehending time, date,
place and events
Unable to successfully prepare food, cook,
clean or shop
unable to live alone safely without
considerable support
Behavior changes may include wandering
repeated questioning, calling out, clinging,
disturbed sleeping, hallucinations
(seeing/hearing things not there)
May display inappropriate behavior in the
home or in the community (e.g.,
disinhibition, aggression)
LATE STAGE (5+ years)
The last stage is one of nearly total dependence and
inactivity. Memory disturbances are very serious and
the physical side of the disease becomes more obvious
Usually unaware of time and place
Have difficulty understanding what is
happening around them
Unable to recognize relatives, friends and
familiar objects
Unable to eat without assistance, may
have difficulty in swallowing
Increasing need for assisted self-care
(bathing and toileting)
May have bladder and bowel
incontinence
Change in mobility. May be unable to
walk or be confined to a wheelchair/bed
Behavior changes, may escalate to
aggression towards carer, nonverbal
agitation (kicking, hitting, screaming or
moaning)
Unable to find his or her way around in
the home
 Prognosis
Difficult to determine life expectancy
Survival after diagnosis: 3-20 years
Average 8 year survival
Depends on age, care, co-morbidities
most of that time in the most severe range
Nursing homes are the most common sites of death
Infection is most common direct cause of mortality

5. Mitchell SL. Advanced dementia. N Engl J Med. 2015.372(26):2533-2540.

6. Gallaway PJ, Miyake H, Buchowski MS, Shimada M, Yoshitake Y, Kim AS, Hongu N. Physical activity: A viable way to reduce the risks of mild cognitive impairment, Alzheimers disease, and vascular
dementia in older adults. Brain Sci. 2017; 7(2): 1-16.
7. Shlisky J, Bloom DE, Beaudreault AR, Tucker KL, et al. Nutritional considerations for healthy aging and reduction in age-related chronic disease. Adv Nutr. 2017; 8(1):17-26.
 Dementia Co-Morbidities
May be successfully treated with return to normal/premorbid state:
Impairment from toxic side effects of Rx
If dementia is Subdural hematoma (usually d/t head injury)
suspected, 1st step Normal pressure hydrocephalus
in intervention Metabolic disorders r/t nutrition (vitamin deficiencies
should be a trial can be resolved with treatment of underlying cause):
of replacing Thiamine
deficient Niacin
nutrients and B6
observe for Folate
improved B12
cognitive function Hypothyroidism
Hypoglycemia
Return to normal state assuming absence of extensive cell
injury
19. Alzheimers and Other Dementias. Nutrition Care Manual. Academy of Tumors (removable)
Nutrition and Dietetics. Available at: http://nutritioncaremanual.org.
 Dementia: An Increasing Public Health Issue
47.5 million people living with
dementia worldwide (WHO)
Growing elderly population
By 2030, >20% US population
will be over 65
7.7 million new diagnoses
annually (every 4 seconds
somewhere in the world!)

8. Alzhiemers Facts and Figures online. Accessed December 10, 2016. www.alz.org/alzheimera_disease_facts_and_figures.asp.
9. Vincent GK, Velkoff VA. Population Estimates and Projections; US Census Bureau: Suitland, MD, USA, 2010.
10. Bernstein R, Edwards T. An Older and More Diverse Nation by Midcentury; US Census Bureau: Suitland, MD, USA, 2008.
11. Cummings JL, Morstorf T, Zhong K. Alzheimers disease drug-development pipeline: Few candidates, frequent failures. Alzheimers Res Ther. 2014; 6(37).
12. World Health Organization and Alzheimers Disease International. Dementia: A Public Health Priority. World Health Organization website. Published 2012. Accessed March 2017. Available at:
http://www.who.int/mental_health/publications/dementia_report_2012/en/.
 Dementia: an Increasing Public Health Issue

12. World Health Organization and Alzheimers Disease International. Dementia: A Public Health Priority. World Health Organization
website. Published 2012. Accessed March 2017. Available at: http://www.who.int/mental_health/publications/dementia_report_2012/en/.
 Common Forms of Dementia
Dementia Categories

Alzhiemers Disease
(AD) the most
common dementia:
70% of dementia cases
Reports range from 50% to 80%

Vascular Dementia
(VaD): at least 20% of
dementia cases
Alzheimer's Disease Vascular Dementia Other Dementias

8. Alzheimers Facts and Figures online. Accessed December 10, 2016. http://www.alz.org/facts/
4. Karantzoulis, S.; Galvin, J.E. Distinguishing Alzheimers disease from other major forms of dementia. Expert Rev. Neurother. 2014, 11, 15791591. [CrossRef] [PubMed]
13. Gorelick PB, Scuteri A, Black SE, DeCarli C, Greenberg SM, Iadecola C, Launer LJ, Laurent S, Lopez OL, Nyenhuis D, et al. Vascular contributions to cognitive impairment and dementia a statement
for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011; 42: 26722713.
 Alzheimers Disease Dementia
Most common
form of dementia
5.4 million affected
in US (2016)
1 in 9 Americans,
aged 65 and older,
with AD
1 in 4 >85 yo
Projection: 14-16
million by 2050
Figure for Washington State

3. Hebert LE, Weuve J, Scherr PA, Evans DA. Alzheimer disease in the United States (20102050) estimated using the 2010 census. Neurology. 2013; 80: 17781783.
14. Alzheimers Association. 2016 Alzheimers Disease Facts and Figures. Alzheimers Dement. 2016, 12, 459509.
15. WHO. Dementia: Fact Sheet No. 362. Geneva, Switzerland, April 2016. Available online: http://www.who.int/mediacentre/factsheets/fs362/en/
 Alzheimers and Mortality in the US: #6
National Leading Causes of Mortality
700000
600000
500000
# of Deaths

400000
300000
200000
100000
0

Causes of Death
14. Alzheimers Association. 2016 Alzheimers Disease Facts and Figures. Alzheimers Dement. 2016, 12, 459509
16. Deaths and Mortality (2014). Fast stats. Centers for Disease Control and Prevention. Accessed March 7, 2017. Available at: https://www.cdc.gov/nchs/fastats/deaths.htm
3rd Leading Cause of Death in WA State

14. Alzheimers Association. 2016 Alzheimers Disease Facts and Figures. Alzheimers Dement.
2016, 12, 459509
17. Alzheimers Statistics: Washington. Alzheimers Association website. Accessed March 17,
2017. Available at:
http://www.alz.org/documents_custom/facts_2016/statesheet_washington.pdf?type=interior_m
ap&facts=undefined&facts=facts
 Risk Factors for Dementia

18. Mayeux R and Stern Y. Epidemiology of Alzheimer Disease. Perspect Med. 2012;2:a006239.
 Most Important Risk Factor: Age
Those Affected by Alzheimer Dementia by Age

The number
50%
of people
with the 40%
disease
30%
doubles
every 5 years 20%
in those 65+
10%
years old
0%
65-74 years 75-84 years >85 years
19. Alzheimers and Other Dementias. Nutrition Care Manual. Academy of Nutrition and Dietetics. Available at: http://nutritioncaremanual.org.
Pathogenesis
Neurodenergative disease with a focus on Alzheimers Dementia
 Neurodegenerative Diseases
Pattern of neuronal
dysfunction
Abnormal proteins
accumulate in and
preferentially affect particular
neurons in specific disorders

Evolving process
changes phenotype
of disease over time
Neurodegenerative diseases
preferentially affect a primary
set of brain regions but other
regions can be involved later
in disease course

1. Kumar V, Abbas AK, Aster JC. Robbins basic pathology. 9th ed. Philadelphia, PA: Elsevier Saunders, 2013.
 Brain regions and cognitive deficits
Cerebral cortical neurons result in (all components of dementia):
Loss of memory
Loss of language
Loss of insight
Loss of planning
Neurons of basal ganglia
Movement disorders
Cerebellum
Ataxia
Motor Neurons
Results in weakness

1. Kumar V, Abbas AK, Aster JC. Robbins basic pathology. 9th ed. Philadelphia, PA: Elsevier Saunders, 2013.
 Pathology of Alzheimers Disease

A Hypothesis
Neuroinflammation
Reactive Oxidative Species

1. Kumar V, Abbas AK, Aster JC. Robbins basic pathology. 9th ed. Philadelphia, PA: Elsevier Saunders, 2013.
20. Manoharan S, Guillemin GJ, Abiramasundari RS, Essa MM, Akvar M, Akbar MD. The role of reactive oxygen species in the pathogenesis of Alzheimers disease, Parkinsons disease, and huntingtons disease:
A mini review. Ox Med Cell Long. 2016; 2016:1-15.
 Alzheimers Disease Histology

1. Kumar V, Abbas AK, Aster JC. Robbins basic pathology. 9th ed. Philadelphia, PA: Elsevier Saunders, 2013.
 Amyloid Beta Hypothesis:
Small aggregates of A may be pathogenic:
alter neurotransmission
toxic to neurons and synaptic endings

Large deposits of A in end-stage AD

Presence of A leads to hyperphosphorylation of
neuronal microtubule binding protein tau.
Tau redistributes from axons into dendrites and cell
bodies
Aggregates into tangles (intracellular lesion)
which contributes to neuron dysfunction and cell
death.

Large deposits - form plaques (extracellular

lesions) which lead to:
neuronal death
elicit local inflammatory response resulting in
further cell injury
may cause altered region-to-region communication
through mechanical effects on axons and dendrites

1. Kumar V, Abbas AK, Aster JC. Robbins basic pathology. 9th ed. Philadelphia, PA: Elsevier
Saunders, 2013.
 Oxidative Stress and AD Pathogenesis

20. Manoharan S, Guillemin GJ, Abiramasundari RS, Essa MM, Akvar M, Akbar MD. The role of reactive oxygen species in the pathogenesis of Alzheimers disease, Parkinsons
disease, and huntingtons disease: A mini review. Ox Med Cell Long. 2016; 2016:1-15.
Dementia and Nutrition
Nutrition Outcomes and Problems
 Expected nutrition-related outcomes

Decreased or abnormal sense of smell and taste

Loss of memory on how to appropriately use eating utensils
Consumption of non-food items
Chewing and swallowing problems
Forgetting to eat
Significant changes in body weight
Behavior changes including movement patterns

19. Alzheimers and Other Dementias. Nutrition Care Manual. Academy of Nutrition and Dietetics. Available at: http://nutritioncaremanual.org.
 Feeding Problems in Advanced Dementia
Most common problems:
CASCADE Study:
Eating problems (86% pts)
323 nursing home residents Oral dysphagia
with advanced dementia pocketing food in the
18 months cheek
Pharyngeal dysphagia
Median survival: 1.3 years causing aspiration
Feeding Problems Nearly Inability to feed oneself
Refusal to eat
Universal
Febrile episodes (53%)
Pneumonia (41%)

5. Mitchell SL. Advanced dementia. New Engl J Med. 2015; 372(26):2533-2540

 Feeding Problems in Dementia cont.
Advanced Dementia Feeding Problems (n = 71)

Dysphagia

Refused/Spit Out Food

Problem

Physical Assistance

Set up/Cueing

0 5 10 15 20 25 30 35
Percentage of group with problem

21. Volicer L, Seltzer B, Rheume Y et al. Eating difficulties in patients with probable dementia of the Alzheimer type. J Geriatr Psychiatry Neurol. 1989; 2:188-195.)
 Mechanisms of Feeding Problems

Varied mechanisms
Apraxia or visuospatial dysfunction affect mechanics of eating
Distracting behaviors interfere with intake
Swallowing is prolonged, poorly coordinated
Dysphagia causes choking, food avoidance

1. Kumar V, Abbas AK, Aster JC. Robbins basic pathology. 9th ed. Philadelphia, PA: Elsevier Saunders, 2013.
 Dementia & Malnutrition
Death in dementia patients usually
Elderly individuals occurs from:
identified at risk of
Malnutrition have: Proximate cause: pneumonia or other
infections often related to nutritional
poorer quality of decline22
life
50% of advanced dementia patients
more likely to be receive a dx of pneumonia in the last 2
admitted to weeks of life23
hospital 6 months after a suspected dx of
pneumonia in advanced dementia
at increased risk of patients, rate of death from any cause is
mortality 50%25

19. Alzheimers and Other Dementias. Nutrition Care Manual. Academy of Nutrition and Dietetics. Available at: http://nutritioncaremanual.org.
22. Hanson LC, Ersek M, Lin FC, Carey TS. Outcomes of feeding problems in advanced dementia in a nursing home population. JAGS. 2013; 61: 1692-1697
23. Chen JH, Lamberg JL, Chen YC, et al. Occurrence and treatment of suspected pneumonia in long-term care residents dying with advancedementia. J Am Geriatr Soc. 2006; 54:290-5
24. Mitchell SL, Teno JM, Kiely DK, et al. The clinical course of advanced dementia. N Engl J med. 2009; 361:1529-38.
25. Morrison RS, Siu AL. Survival in end-stage dementia following acute illness. JAMA. 2000; 22:120-4.
 Malnutrition/Unintended Weight Loss
Populations of care homes are likely to be suffering from a
range of illnesses
many illnesses affect bodys ability to gain weight
In 6 of 7 studies that observed this issue, residents had
dementia
Raised metabolism and increased energy
expenditures have been suggested to explain why weight
loss is more common in dementia, especially as it
progresses

26. Keller HH, Gibbs AJ, Boudreau LD, Goy RE, Pattillo MS, Brown HM. Prevention of weight loss in dementia with comprehensive nutritional treatment. J Am Geriatrics Soc. 2003; 51: 945-952.
Nutrition Interventions
What does the literature suggest?
 2013 Systematic Review

22 Intervention Studies
(9 RCT)
2082 older adults
85 LTC facilities
8 Strong Studies
11 Moderate Studies

5 categories:
Nutrition Supplements
Training/Ed programs
Environment
modification
Feeding assistance
Mixed Intervention

27. Liu W, Cheon J, Thomas SA. Interventions on mealtime difficulties in older adults with dementia: A systematic review. Intl J Nurs St. 2014. 51: 14-27.
 Liu et als Grade Definitions

27. Liu W, Cheon J, Thomas SA. Interventions on mealtime difficulties in older adults with dementia: A systematic review. Intl J Nurs St. 2014. 51: 14-27.
 Oral Nutritional Supplements
Strong Studies Moderate Studies

1 CCT, 4 RCTs 2 RCTs

Increase in energy, protein, Increase in body weight,
CHO consumption BMI, fat free mass at 3
Tricep skin fold thickness months
Increase in biochemical
Mid-upper-arm
parameters
circumference
albumin, hemoglobin, serum
Biochemical parameters ferritin
serum magnesium, zinc,
selenium

27. Liu W, Cheon J, Thomas SA. Interventions on mealtime difficulties in older adults with dementia: A systematic review. Intl J Nurs St. 2014. 51: 14-27.
 Supplements in a Glass
versus Straw in Standard Container
RCT (2013 study)
45 participants
Mean age: 86.7 yo
Participants randomized to
consume nutritional drinks from
a glass/beaker drank statistically,
significantly more than those
who had a straw directly in the
container.
Recommendation: dementia
patients to be given nutritional
supplement drinks in a
glass/beaker if resources allow

28. Allen VJ, Methven L, Gosney M. Impact of serving method on the consumption of nutritional supplement drinks: randomized trial in older adults with cognitive
impairment. J Adv Nurs. 2014; 70(6): 1323-33.
 Environmental Changes
Moderate Studies
High Contrast Red/Blue Tableware
Weak Studies
Relaxing Music at Mealtimes
2 interrupted time series
2 interrupted time series
25% increase in food & liquid intake
from baseline Agitation reported as decreased but not
significantly
Bulk Food Service
Food intake increased
More home-like environment
Significant increase in 24 hr total and
dinner protein intake
Soothing Music at Mealtimes
Interrupted time series & cohort
20% more kcal intake with familiar
background music
Decline in agitation from baseline

27. Liu W, Cheon J, Thomas SA. Interventions on mealtime difficulties in older adults with dementia: A systematic review. Intl J Nurs St. 2014. 51: 14-27.
 Training/Ed Programs
Strong Studies Moderate Studies

2 RCTs with Montessori Feeding Skills Training program for

CNAs (CCT)
methods
More knowledge and positive
Decrease in EdFED attitude/behaviors
Increased eating ability no difference in pt food intake

Increased self-feeding Health & Nutrition promo program

frequency and time for physicians, caregivers and patients
with dementia (NutriAlz) (RCT)
Increased MNA
No difference in BMI, BW, dementia
severity, behavior problems, eating ability
29. Sheppard CL, McArthur C, Hitzig SL. A systematic review of Montessori-based activities for persons with dementia. JAMDA. 2016; 17: 117-122.
27. Liu W, Cheon J, Thomas SA. Interventions on mealtime difficulties in older adults with dementia: A systematic review. Intl J Nurs St. 2014. 51: 14-27.
 Feeding Assistance
Moderate Studies
2 Interrupted time series and CCT
Individualized feeding assistance
Mealtime assistance or between-meal
snack delivery
Increase in total intake, assistance time
from usual care.
Staff time required for meal assistance:
35-42 min/resident meal versus
usual care 5-6 min/resident meal
Staff time required for snack assistance
14 min/snack versus usual care 1
min/snack
27. Liu W, Cheon J, Thomas SA. Interventions on mealtime difficulties in older adults with dementia: A systematic review. Intl J Nurs St. 2014. 51: 14-27.
30. Image from: Encouraging eating: Advice for at-home dementia caregivers. Alzheimers disease education and referral center. National Institute on Aging. NIH website. Available
at: https://www.nia.nih.gov/alzheimers/features/encouraging-eating-advice-home-dementia-caregivers.
 EN/PN and Dementia
2009 Cochrane Review of Observational Studies
Concluded insufficient evidence to support benefits of Enteral Nutrition in
patients with advanced dementia in terms of survival, QOL, nutrition,
functional status, prevention of aspiration, prevention of pressure ulcers
Several organizations have published recommendations against
Enteral Nutrition in patients with advanced dementia
American Geriatrics Society
ABIM Foundation
Alzheimers Association
Evidence suggests PEG Feeding does not extend life expectancy,
improve prognosis, or contribute to increased QOL

Families must be provided accurate and thorough info on which to base the decision of whether to use
this aggressive method of nutritional intake w/o influence of bias of those providing this info

19. Alzheimers and Other Dementias. Nutrition Care Manual. Academy of Nutrition and Dietetics. Available at: http://nutritioncaremanual.org.
 Increasing Intake in Advanced Dementia
Hand Feeding Snacks
When Palliation is the focus 2 RCTs provided weak
Not for ensuring prescribed caloric intake evidence of increased daily
Takes time intake snack provision
Allows patient to enjoy food and social interaction
compared with usual care
20% increased intake
132 additional kcals
20-25% increased intake in
3 month controlled trial of
snacks
31. Lorefalt B and Wilhelmsson S. A multifaceted intervention model can give lasting improvement of older peoples nutritional status. IJ Nutr, Health Aging. 2012; 16: 378-382.)
 Pharmacological Therapy Review
Short term alleviation of Cholinesterase inhibitors
symptoms (6-18 months) Donepezil and Revastigime
Allows brain to compensate Blocks cholinesterase: an
for neuron loss enzyme that breaks down
communication via neurotransmitter acetylcholine
acetylcholine Glutamatergic agents
(neurotransmitter)
memantine
Does not affect pathology Glutamatergic NMDA receptor
blocker
Rx approved in US & Europe:
Effective for mod-severe AD
Cholinesterase inhibitors
Memantine

32. Medications for Memory Loss. Alzheimers Association website. Available at: http://www.alz.org/alzheimers_disease_standard_prescriptions.asp
 Pharmaceuticals for AD

33. Alzheimers Disease Treatments. Alzheimers Association website. Available at: http://www.alz.org/research/science/alzheimers_disease_treatments.asp
Developing pharmaceuticals
More than 100
compounds in
development

Targets proteins
circulating A
protein

Side Effects/DNIs
 Souvenaid by Nutricia
Contains
FortasynConnect
Omega-3 Fatty Acids (DHA/EPA)
Choline
Uridine monophosphate
Phospholipids
Antioxidants (vitamin C, E)
B Vitamins (folic acid, B12, B6)
Selenium

10 years of research so
far
Generally well tolerated with high
compliance (94%)
Verbal recall and very mild
dementia

Ongoing clinical trials

34. Souvenaid website. Available at: http://www.souvenaid-us.com/index.htm
35. Onakpoya IJ, Heneghan CJ. The efficacy of supplementation with the novel medical food, Souvenaid, in patients with Alzheimers disease: A systematic review and
meta-analysis of randomized clinical trials. Nutr neuroscience. 2017; 20(4): 219-227.
36. Gallaway PJ, Miyake H, Buchowski MS, Shimada M, Yoshitake Y, Kim AS, Hongu N. Physical activity: A viable way to reduce the risks of mild cognitive impairment,
Alzheimers disease, and vascular dementia in older adults. Brain Sci. 2017; 7(2): 1-16.
Prevention
Fostering a Healthy Brain and CNS via Lifestyle Choices
 Causes of Oxidative Stress in Alzheimer's Dementia

20. Manoharan S, Guillemin GJ, Abiramasundari RS, Essa MM, Akvar M, Akbar MD. The role of reactive oxygen species in the pathogenesis of Alzheimers disease, Parkinsons
disease, and huntingtons disease: A mini review. Ox Med Cell Long. 2016; 2016:1-15.
Mitochondria in the Brain & CNS
Brain & CNS
2% of body weight
20% of energy needs!

High concentrations
of mitochondria in
brain and nervous
system
Mitochondria highly
susceptible to
oxidative stress and
damage
Loss of mitochondria
with age
37. English J and Dean W. Mitochondrial dysfunction, nutrition, and aging.
Nutr Review. 2013. Available at:
http://nutritionreview.org/2013/09/mitochondrial-dysfunction
 Individual Foods and Compounds
Epidemiological, in vivo, in vitro studies suggest promising
neuroprotective effects from:
Vitamins
E, Bs, D
Omega-3 fatty acid (DHA/EPA)
Monounsaturated fatty acids, polyunsaturated fatty acids
Eggs
Carotenoids
Crocin, water-soluble (saffron)
Polyphenols
Cocoa flavonoids
Isothiocyanates (cruciferous vegetables)
Curcumin (Turmeric)
Many other compounds in plant-foods
38. Finley JW, Gao S. A perspective on crocus sativus L. (Saffron) constituent crocin: A potent water-soluble antioxidant and potential therapy for alzheimers diase. J Agric Food Chem. 2017; 65(5): 1005-1020.
39. Littlejohns TJ, Henley WE, Lan IA, Annweiler C, Beauchet O, Chaves PH, Fried L, Kestenbaum BR, Kuller LH, Langa KM, Lopez OL, Kos K, SOni M, Llewellyn DJ. Vitamin D and the risk of dementia and
Alzheimer disease. Neurology. 2014; 83(10): 920-928.
40. Belkouch M, Hachem M, Elgot A, Van AL, Picq M, Guichardant M, Lagarde M, Bernoud-Hubac L. The pleiotropic effects of omega-3 docasahexaenoic acid on the hallmarks of Alzheimers disease. J Nutr
Biochem. 2016 (38): 1-11
41. Ylilauri MP, Voutilainen S, Lonnroos E, Mursu J, et al. Association of dietary cholesterol and egg intakes with the risk of incident dementia or Alzheimer disease: the Kuopio ischaemic heart disease risk factor
study. Am J Clin Nutr. 2017; 105(2): 476-484.
Diet Patterns & AD
Mediterranean Diet
DASH diet
MIND Diet
 MIND Diet: 15 Dietary Components
10 Brain Healthy Foods 5 Unhealthy Foods
Green leafy vegetables Red meats
Other vegetables Butter and stick margarine
Nuts Cheese
Berries Pastries and Sweets
Beans Fried or fast foods
Whole grains
Fish
Poultry
Olive oil
wine

42. What are the Components to the MIND diet? From the Acadmy: Question of the month. Eatright website. JAND. 2015; 8(2): 1744. Available at: http://dx.doi.org/10.1016/j.jand.2015.08.002
43. Morris MC, Tangney CC, Wang Y, Sacks FM, Bennett DA, Aggarwal NT. MIND diet associated with reduced incidence of alzheimers disease. Alzheimers & Dementia. 2015; 11: 1007-1014.
44. Morris MC. Nutrition and risk of dementia: overview and methodological issues. Ann. NY Acad Sci. 2016; 1367: 31-37.
Image from Rush University website. Available at: https://www.rush.edu/news/press-releases/study-diets-impact-dementia-alzheimers-disease-begins-January.
 Nutrients of Concern for CNS Health & Aging
Vitamin D: B6, B12, folate
muscle and bone strength/stability Methylation for Neurotransmitters,
repairing nerve tissue
anti-inflammatory
Selenium, Cu, Zn, Mg
EFAs, phospholipids
Cofactors, mitochondrial nutrients
Cellular membranes, building
myelin Fluids
Eggs, fish
Bioactive Compounds in plants:
Protein anti-inflammatory
Build cells, neurotransmitters, supports detoxification
enzymes, etc.
Low Glycemic Load CHO Microbiota-Gut-Brain (MGB)
Axis (Montiel Castro AJ)
Sustainable energy

37. English J and Dean W. Mitochondrial dysfunction, nutrition, and aging. Nutr Review. 2013. Available at: http://nutritionreview.org/2013/09/mitochondrial-dysfunction
48. Montiel-Castro AJ, Gonzalez-Cervantes RM, Bravo-Ruiseco G, Pacheco-Lopez G. Frontiers Neur. 2014; 7(70): 1-16.)
 Physical Activity

Increased blood
flow to the
brain
Improved CVD
and Metabolic
Health
Improved
hypertension
A main risk factor
for MCI, AD, VaD

6. Gallaway PJ, Miyake H, Buchowski MS, Shimada M, Yoshitake Y, Kim AS, Hongu N. Physical activity: A viable way to reduce the risks
of mild cognitive impairment, Alzheimers disease, and vascular dementia in older adults. Brain Sci. 2017; 7(2): 1-16.
 SAIDO Learning: Brain Exercises
5x/wk, 15-30 min
Supporter leads
Learners
Objective: engage
Learner in
accomplishing
repeated successful
exercises,
progressing to new
material at Learners
level and pace
Reading Aloud
Writing
Simple mathematics

48. Kawashima R, Hiller DL, Sereda SL, Antonczak M, Serger K, GannonD, Ito S, Otake H, Yunomae D, Kobayashi A, Muller C, Murata H, FallCreek S. SAIDO learning as a cognitive intervention for dementia
care. JAMDA. 2015; 16: 56-62
49. Kawashima R. Mental exercises for cognitive function: Clinical evidence. J Prev Med Public Health. 2013; 46:S22-S27.
 SAIDO Language & Arithmetic Materials Examples

48. Kawashima R, Hiller DL, Sereda SL, Antonczak M, Serger K, GannonD, Ito S, Otake H,
Yunomae D, Kobayashi A, Muller C, Murata H, FallCreek S. SAIDO learning as a cognitive
intervention for dementia care. JAMDA. 2015; 16: 56-62
49. Kawashima R. mental exercises for cognitive function: Clinical evidence. J Prev Med
Public Health. 2013; 46:S22-S27.
SAIDO Learning: Eliza Jennings Research

Activation of combinations of brain processes through simple

reading, writing and arithmetic tasks.
Foundation Interventions:
Healthy Brain and Nervous System
Meet nutrition needs
Decrease toxic exposures/increase antioxidants
Decrease inflammation
Decrease emotional stress
Increase physical activity
Increase mental stimulation
 Conclusions:
Smart Aging and Quality of Life
Kawashimas Four Factors
of Smart Aging: Quality of life can be improved
even at end of life when a social
1. Cognitive Stimulation system focuses on four factors that
constitute smart aging
2. Regular Exercise Quality of life throughout life
3. Balanced Nutrition prior to aging
Public health perspective:
4. Relationship with prevention might be the greatest
Society intervention

49. Kawashima R. Mental exercises for cognitive function: Clinical evidence. J Prev Med Public Health. 2013; 46:S22-S27
Thank you!
Questions?
Joyce.s.moon@gmail.com

Joyce Moon, MSN

Dietetic Intern
Sodexo Dietetic Internships
References
1. Kumar V, Abbas AK, Aster JC. Robbins basic pathology. 9th ed. Philadelphia, PA: Elsevier Saunders, 2013.
2. Sheehan B. Assessment scales in dementia. Ther Adv Neurol Disord. 2012; 5(6): 349-358.
3. Hebert LE, Weuve J, Scherr PA, Evans DA. Alzheimer disease in the United States (20102050) estimated using the 2010 census.
Neurology. 2013; 80: 17781783.
4. Karantzoulis S, Galvin JE. Distinguishing Alzheimers disease from other major forms of dementia. Neurother. 2014; 11: 15791591.
5. Mitchell SL. Advanced dementia. N Engl J Med. 2015.372(26):2533-2540.
6. Gallaway PJ, Miyake H, Buchowski MS, Shimada M, Yoshitake Y, Kim AS, Hongu N. Physical activity: A viable way to reduce the
risks of mild cognitive impairment, Alzheimers disease, and vascular dementia in older adults. Brain Sci. 2017; 7(2): 1-16.
7. Shlisky J, Bloom DE, Beaudreault AR, Tucker KL, et al. Nutritional considerations for healthy aging and reduction in age-related
chronic disease. Adv Nutr. 2017; 8(1):17-26.
8. Alzhiemers Facts and Figures online. Accessed December 10, 2016. www.alz.org/alzheimera_disease_facts_and_figures.asp.
9. Vincent GK, Velkoff VA. Population Estimates and Projections; US Census Bureau: Suitland, MD, USA, 2010.
10. Bernstein R, Edwards T. An Older and More Diverse Nation by Midcentury; US Census Bureau: Suitland, MD, USA, 2008.
11. Cummings JL, Morstorf T, Zhong, K. Alzheimers disease drug-development pipeline: Few candidates, frequent failures.
Alzheimers Res Ther. 2014; 6 (37).
12. World Health Organization and Alzheimers Disease International. Dementia: A Public Health Priority. World Health
Organization website. Published 2012. Accessed March 2017. Available at:
http://www.who.int/mental_health/publications/dementia_report_2012/en/.
13. Gorelick PB, Scuteri A, Black SE, DeCarli C, Greenberg SM, Iadecola C, Launer LJ, Laurent S, Lopez OL, Nyenhuis D, et al.
Vascular contributions to cognitive impairment and dementia a statement for healthcare professionals from the American Heart
Association/American Stroke Association. Stroke. 2011; 42: 26722713.
References
14. Alzheimers Association. 2016 Alzheimers Disease Facts and Figures. Alzheimers Dement. 2016, 12, 459509.
15. WHO. Dementia: Fact Sheet No. 362. Geneva, Switzerland, April 2016. Available online:
http://www.who.int/mediacentre/factsheets/fs362/en/
16. Deaths and Mortality (2014). Fast stats. Centers for Disease Control and Prevention. Accessed March 7, 2017. Available at:
https://www.cdc.gov/nchs/fastats/deaths.htm
17. Alzheimers Statistics: Washington. Alzheimers Association website. Accessed March 17, 2017. Available at:
http://www.alz.org/documents_custom/facts_2016/statesheet_washington.pdf?type=interior_map&facts=undefined&facts=facts
18. Mayeux R and Stern Y. Epidemiology of Alzheimer Disease. Perspect Med. 2012;2:a006239.
19. Alzheimers and Other Dementias. Nutrition Care Manual. Academy of Nutrition and Dietetics. Available at:
http://nutritioncaremanual.org.
20. Manoharan S, Guillemin GJ, Abiramasundari RS, Essa MM, Akvar M, Akbar MD. The role of reactive oxygen species in the
pathogenesis of Alzheimers disease, Parkinsons disease, and huntingtons disease: A mini review. Ox Med Cell Long. 2016; 2016:1-15.
21. Volicer L, Seltzer B, Rheume Y et al. Eating difficulties in patients with probable dementia of the Alzheimer type. J Geriatr
Psychiatry Neurol. 1989; 2:188-195.
22. Hanson LC, Ersek M, Lin FC, Carey TS. Outcomes of feeding problems in advanced dementia in a nursing home population.
JAGS. 2013; 61: 1692-1697
23. Chen JH, Lamberg JL, Chen YC, et al. Occurrence and treatment of suspected pneumonia in long-term care residents dying with
advancedementia. J Am Geriatr Soc. 2006; 54:290-5
24. Mitchell SL, Teno JM, Kiely DK, et al. The clinical course of advanced dementia. N Engl J med. 2009; 361:1529-38
25. Morrison RS, Siu AL. Survival in end-stage dementia following acute illness. JAMA. 2000; 22:120-4.
26. Keller HH, Gibbs AJ, Boudreau LD, Goy RE, Pattillo MS, Brown HM. Prevention of weight loss in dementia with comprehensive
nutritional treatment. J Am Geriatrics Soc. 2003; 51: 945-952.
References
27. Liu W, Cheon J, Thomas SA. Interventions on mealtime difficulties in older adults with dementia: A systematic review. Intl J Nurs
St. 2014. 51: 14-27.
28. Allen VJ, Methven L, Gosney M. Impact of serving method on the consumption of nutritional supplement drinks: randomized
trial in older adults with cognitive impairment. J Adv Nurs. 2014; 70(6): 1323-33.
29. Sheppard CL, McArthur C, Hitzig SL. A systematic review of Montessori-based activities for persons with dementia. JAMDA.
2016; 17: 117-122.
30. Image from: Encouraging eating: Advice for at-home dementia caregivers. Alzheimers disease education and referral center.
National Institute on Aging. NIH website. Available at: https://www.nia.nih.gov/alzheimers/features/encouraging-eating-advice-
home-dementia-caregivers.
31. Lorefalt B and Wilhelmsson S. A multifaceted intervention model can give lasting improvement of older peoples nutritional
status. IJ Nutr, Health Aging. 2012; 16: 378-382.)
32. Medications for Memory Loss. Alzheimers Association website. Available at:
http://www.alz.org/alzheimers_disease_standard_prescriptions.asp
33. Alzheimers Disease Treatments. Alzheimers Association website. Available at:
http://www.alz.org/research/science/alzheimers_disease_treatments.asp
34.Souvenaid website. Available at: http://www.souvenaid-us.com/index.htm
35. Onakpoya IJ, Heneghan CJ. The efficacy of supplementation with the novel medical food, Souvenaid, in patients with Alzheimers
disease: A systematic review and meta-analysis of randomized clinical trials. Nutr neuroscience. 2017; 20(4): 219-227.
36. English J and Dean W. Mitochondrial dysfunction, nutrition, and aging. Nutr Review. 2013. Available at:
http://nutritionreview.org/2013/09/mitochondrial-dysfunction
37. Finley JW, Gao S. A perspective on crocus sativus L. (Saffron) constituent crocin: A potent water-soluble antioxidant and potential
therapy for alzheimers diase. J Agric Food Chem. 2017; 65(5): 1005-1020.
References
38. Littlejohns TJ, Henley WE, Lan IA, Annweiler C, Beauchet O, Chaves PH, Fried L, Kestenbaum BR, Kuller LH, Langa KM, Lopez
OL, Kos K, SOni M, Llewellyn DJ. Vitamin D and the risk of dementia and Alzheimer disease. Neurology. 2014; 83(10): 920-928.
39. Belkouch M, Hachem M, Elgot A, Van AL, Picq M, Guichardant M, Lagarde M, Bernoud-Hubac L. The pleiotropic effects of
omega-3 docasahexaenoic acid on the hallmarks of Alzheimers disease. J Nutr Biochem. 2016 (38): 1-11
40. Ylilauri MP, Voutilainen S, Lonnroos E, Mursu J, et al. Association of dietary cholesterol and egg intakes with the risk of incident
dementia or Alzheimer disease: the Kuopio ischaemic heart disease risk factor study. Am J Clin Nutr. 2017; 105(2): 476-484.
41. What are the Components to the MIND diet? From the Acadmy: Question of the month. Eatright website. JAND. 2015; 8(2):
1744. Available at: http://dx.doi.org/10.1016/j.jand.2015.08.002
42. Morris MC, Tangney CC, Wang Y, Sacks FM, Bennett DA, Aggarwal NT. MIND diet associated with reduced incidence of
alzheimers disease. Alzheimers & Dementia. 2015; 11: 1007-1014.
43. Morris MC. Nutrition and risk of dementia: overview and methodological issues. Ann. NY Acad Sci. 2016; 1367: 31-37.
44. Mediterranean Diet. Traditional Diets. Oldways website. Available at: https://oldwayspt.org/traditional-
diets/mediterranean-diet
45. Abuznait AH, Qosa H, Busnena BA, Sayed KA, Kaddoumi A. Olive-oil-derived oleocanthal enhances beta-amyloid clearance as a
potential neuroprotective mechanism against alzheimers disease: In vitro and in vivo studies. ACS Chem Neurosci. 2013; 4(6): 973-
982.
46. Image from Rush University website. Available at: https://www.rush.edu/news/press-releases/study-diets-impact-dementia-
alzheimers-disease-begins-January.
47. Montiel-Castro AJ, Gonzalez-Cervantes RM, Bravo-Ruiseco G, Pacheco-Lopez G. Frontiers Neur. 2014; 7(70): 1-16.)
48. Kawashima R, Hiller DL, Sereda SL, Antonczak M, Serger K, GannonD, Ito S, Otake H, Yunomae D, Kobayashi A, Muller C,
Murata H, FallCreek S. SAIDO learning as a cognitive intervention for dementia care. JAMDA. 2015; 16: 56-62
49. Kawashima R. Mental exercises for cognitive function: Clinical evidence. J Prev Med Public Health. 2013; 46:S22-S27.