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The Importance of Nutrition for
Brain Health and during Brain
Disease
Diewerke de Zwarte
Let’s Talk About Brain Health & Brain Disease
27/8/2018
Outline
• Nutrition to maintain brain health
– Cardiovascular health
– Lifestyle factors
• Nutrition during brain disease
– How may Parkinson’s Disease and Dementia
affect eating and drinking?
– Tips which may help
– Useful resources
Nutrition for Brain Health
• Ongoing Research
• No Magic bullet –Lifestyle
approach
• Sufficient evidence to support a
link between some modifiable
risk factors and a reduced risk
for cognitive decline, dementia
and Parkinson’s disease.
Cardiovascular health
• Diabetes
– Prevention: Type 2 diabetes = healthy weight
and diet
– Management: diet, exercise and medication
• Mid-life obesity – not later life
– Healthy balanced diet and exercise
• Mid-life high blood pressure
– Moderate salt intake and healthy weight
• Cholesterol
– Reduce saturated fat, more unsaturated fats.
Lifestyle
• Physical activity
– Related to nutrition as helps to maintain healthy weight
• Diet
– Whole dietary pattern approach
– Mediterranean diet (focus on wholegrains, fruits and vegetables,
fish, nuts, healthy oils - relatively little red meat).
– DASH Diet (dietary approaches to stop hypertension): No
added salt, Lots of vegetables and fruit, wholegrains, low fat
dairy, less meat/poultry/fish, some nuts/seeds/legumes
• Alcohol
– Small to moderate alcohol consumption
How may Parkinson’s Disease and
Dementia affect your eating and drinking?
Many will not experience difficulties with eating and
drinking!
Healthy eating advice as for the rest of our population!
- Food pyramid
- Maintain healthy weight
- Regular exercise
Nutrition difficulties you might face with Parkinson’s Disease
Slowness of movement
Motor fluctuations
“on” and “off” periods
Swallowing difficulties
Medication interactions
Difficulties preparing
meals
Loss of smell
Loss of Appetite
Constipation
Nutrition difficulties you might face with
Dementia
Poor hand-mouth co-ordination
Taste and smell
changes Loss of interest in
food
Paranoia/ Depression
Swallowing Difficulties
Difficulty understanding
the meal process Walking
about during meals
Agitation Shaking/ tremor
Loss of appetite
Constipation
Suspicious of food
Undernutrition
“ Food, however good, is of no nutritional value
unless it is eaten”
Dept. of Health, 1995.
• Weight loss is common, and increases with disease
progression and severity.
• 25% of people coming into hospital are malnourished.
• Malnutrition increases risk of infection, disability and
death.
Parkinson’s Disease Specific
• Motor fluctuations
• Medication Interactions
Dementia Specific
• Walking about during meals
• Difficulty understanding the meal process
• Agitation/ suspicion of food
Both
• Difficulty preparing meals
• Difficulty getting food from plate to mouth
• Taste changes
• Swallowing difficulties
• Constipation
• Loss of appetite
Nutrition difficulties:
Parkinson’s Disease specific
• Motor Fluctuations
– Eat when you feel most comfortable, Snacks can be helpful
• Medication Interactions – Levodopa can cause nausea and vomiting
– Dopamine agonists (pergolide, apomorphine) can cause nausea and vomiting and psychiatric problems
– MAO-B inhibitors (selegiline) can cause insomnia and induce daytime sleeping
– Anticholergenics (benzhexol) can cause dry mouth, constipation and nausea
– Amantidine can cause confusion, hallucinations, insomnia and dry mouth
Protein and Levodopa
• Protein interferes with the absorption of levodopa
• Recommend taking levodopa 45 minutes before a meal
• If nausea is an issue take levodopa with a low protein snack e.g. cracker, biscuit.
• Some studies show dietary protein redistribution can help improve medication efficacy. This is an experimental technique and is NOT standard practice.
Nutrition difficulties:
Dementia specific
• Walking around during meals
– Finger foods
– Lunch boxes
– Encouragement
• Difficulty understanding the meal process
– Mealtime environment
– Colours
– Assistance
– Finger foods
– Encourage to engage in preparing for the meal
Nutrition difficulties:
Dementia specific
• Agitation (refusing to eat, “No”)
– Meal time environment
– Take away meal and serve again
5-10 minutes later
– Reason for refusing?
• Suspicious of food
– Avoid mixing tablets into meals
– Is there a problem with the food?
Spicy, hot, cold?
– Consider “liked” and familiar foods
Nutrition Difficulties
• Difficulty Preparing
Meals
– Encourage independence
– Help grocery shopping
– Ready meals
– Meals on wheels
– Frozen foods and long
shelf-life foods
– Easy access foods:
Grated cheese, chopped
carrots, sliced bread.
Nutrition Difficulties
• Difficulty getting food from plate to
mouth
– Adaptive cutlery from Occupational
Therapist
– Use a non slip mat or damp cloth
underneath the plate or bowl
– Large handled cutlery
– Two handled cups to reduce spillage
– A “stay-warm” plate to keep food hot or
microwave midway through the meal
– Use energy dense finger foods
Nutrition Difficulties
• Taste changes
– Enjoyed foods
– Food combinations
– Strongly flavoured
foods: salt, sweet,
sour, spicy.
– Cold v’s hot foods
Nutrition Difficulties
• Swallowing difficulties
– Common in Parkinson’s disease and
later-stage Dementia
– May require a modified consistency
diet e.g. smooth puree diet
– May require modified consistency
fluids
– Need speech and language
therapist involvement
– Need to be referred to the dietitian
as modified consistency diets may
be nutritionally inadequate
Nutrition Difficulties
• Loss of appetite – Eat little and often – aim for 3 meals and 2-3 snacks
– Aim to use at least 1 x pint full fat milk/day – as drink,
in cereal, sauces, soup, puddings etc.
– Avoid “low fat” and “diet” food and drinks
– Food can be made more nourishing by adding extra
butter, margarine, cream or cheese to savoury foods
or extra honey, jam or cream to sweet foods
Nutrition Difficulties
• Oral nutritional supplements may be used to
supplement your diet
• Enteral nutrition may be used to prevent or
reverse nutritional deficits during periods of poor
intake or swallowing difficulties.
• As the disease progresses, quality of life and
comfort should be our priority.
• May come a time when someone will completely
refuse food and drinks. Part of natural process
and does not cause distress or discomfort.
Summary
• Nutrition-related modifiable risk factors
• Most do not experience nutritional difficulties.
• Some nutritional difficulties specific to Parkinson’s Disease
and Dementia.
• Seek the help from your dietitian - GP can refer, also in
hospital
• OT and SLT can help reduce nutrition difficulties also.
Thank you for your time!
Gladly welcome any questions
Useful Links
• Nutrition and Dementia: A practical guide
when caring for a person with dementia
(https://www.indi.ie/images/Dementia_Book
let__.pdf)
• Eating well with Parkinson’s Disease
(https://www.indi.ie/resources/fact-
sheets/515-eating-well-with-parkinson-s-
disease.html)
Useful References
• Baumgarta M, Snyderb HM et al, Summary of the evidence on
modifiable risk factors for cognitive decline and dementia: A
population-based perspective, Alzheimer’s & Dementia 11 (2015)
718-726
• Dauncey MJ, Symposium on ‘Early nutrition and later disease:
current concepts, research and implications’ New insights into
nutrition and cognitive neuroscience, Proceedings of the Nutrition
Society (2009), 68, 408–415
• Miller DB, O’Callaghan JP. Do early-life insults contribute to the late-
life development of Parkinson and Alzheimer diseases? Metabolism
(2008)5,2, 44-49
• Volkert D, Chourdakis M et al, ESPEN guidelines on nutrition in
dementia, Clinical Nutrition 34 (2015) 1052e1073
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